Factors Associated With Otolaryngologists Performing Tracheotomy.

Autor:	Soliman SI; Department of Otolaryngology, University of California San Diego, La Jolla., Panuganti BA; Department of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham., Francis DO; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison., Pang J; Department of Otolaryngology-Head & Neck Surgery, Louisiana State University, Shreveport., Klebaner D; Department of Otolaryngology, University of California San Diego, La Jolla., Asturias A; Department of Otolaryngology, University of California San Diego, La Jolla., Alattar A; Department of Otolaryngology, University of California San Diego, La Jolla., Wood S; Department of Otolaryngology, University of California San Diego, La Jolla., Terry M; Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio., Bryson PC; Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio., Tipton CB; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston., Zhao EE; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston., O'Rourke A; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston., Santa Maria C; Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, California., Grimm DR; Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, California., Sung CK; Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, California., Lao WP; Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California., Thompson JM; Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California., Crawley BK; Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California., Rosen S; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison., Berezovsky A; Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor., Kupfer R; Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor., Hennesy TB; Department of Otolaryngology-Head & Neck Surgery, University of Colorado School of Medicine, Aurora., Clary M; Department of Otolaryngology-Head & Neck Surgery, University of Colorado School of Medicine, Aurora., Joseph IT; Department of Otolaryngology-Head and Neck Surgery, UC Davis Health, Sacramento., Sarhadi K; Department of Otolaryngology-Head and Neck Surgery, UC Davis Health, Sacramento., Kuhn M; Department of Otolaryngology-Head and Neck Surgery, UC Davis Health, Sacramento., Abdel-Aty Y; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona., Kennedy MM; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona., Lott DG; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona., Weissbrod PA; Department of Otolaryngology, University of California San Diego, La Jolla.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2023 Dec 01; Vol. 149 (12), pp. 1066-1073.
DOI:	10.1001/jamaoto.2023.2698
Abstrakt:	Importance: Tracheotomies are frequently performed by nonotolaryngology services. The factors that determine which specialty performs the procedure are not defined in the literature but may be influenced by tracheotomy approach (open vs percutaneous) and other clinicodemographic factors. Objective: To evaluate demographic and clinical characteristics associated with tracheotomies performed by otolaryngologists compared with other specialists and to differentiate those factors from factors associated with use of open vs percutaneous tracheotomy. Design, Setting, and Participants: This multicenter, retrospective cohort study included patients aged 18 years or older who underwent a tracheotomy for cardiopulmonary failure at 1 of 8 US academic institutions between January 1, 2013, and December 31, 2016. Data were analyzed from September 2022 to July 2023. Exposure: Tracheotomy. Main Outcomes and Measures: The primary outcome was factors associated with an otolaryngologist performing tracheotomy. The secondary outcome was factors associated with use of the open tracheotomy technique. Results: A total of 2929 patients (mean [SD] age, 57.2 [17.2] years; 1751 [59.8%] male) who received a tracheotomy for cardiopulmonary failure (652 [22.3%] performed by otolaryngologists and 2277 [77.7%] by another service) were analyzed. Although 1664 of all tracheotomies (56.8%) were performed by an open approach, only 602 open tracheotomies (36.2%) were performed by otolaryngologists. Most tracheotomies performed by otolaryngologists (602 of 652 [92.3%]) used the open technique. Multivariable regression analysis revealed that self-reported Black race (odds ratio [OR], 1.89; 95% CI, 1.52-2.35), history of neck surgery (OR, 2.71; 95% CI, 2.06-3.57), antiplatelet and/or anticoagulation therapy (OR, 1.74; 95% CI, 1.29-2.36), and morbid obesity (OR, 1.54; 95% CI, 1.24-1.92) were associated with greater odds of an otolaryngologist performing tracheotomy. In contrast, history of neck surgery (OR, 1.36; 95% CI, 0.96-1.92), antiplatelet and/or anticoagulation therapy (OR, 0.80; 95% CI, 0.56-1.14), and morbid obesity (OR, 0.94; 95% CI, 0.74-1.19) were not associated with undergoing open tracheotomy when performed by any service, and Black race (OR, 0.56; 95% CI, 0.44-0.71) was associated with lesser odds of an open approach being used. Age-adjusted Charlson Comorbidity Index score greater than 4 was associated with greater odds of both an otolaryngologist performing tracheotomy (OR, 1.26; 95% CI, 1.03-1.53) and use of the open tracheotomy technique (OR, 1.48, 95% CI, 1.21-1.82). Conclusions and Relevance: In this study, otolaryngologists were significantly more likely than other specialists to perform a tracheotomy for patients with history of neck surgery, morbid obesity, and ongoing anticoagulation therapy. These findings suggest that patients undergoing tracheotomy performed by an otolaryngologist are more likely to present with complex and challenging clinical characteristics.
Databáze:	MEDLINE
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