303: Why Tracheostomy Protocols Should Fear Bmi Less Than Expected: A Nationwide Inpatient Analysis

Introduction: Tracheostomy in obese patients presents unique challenges. Although morbid obesity (BMI≥40) is known to increase procedural complexity, its impact on post-tracheostomy complications, inpatient outcomes, and readmission rates compared to moderate obesity (BMI 30-39.9) is not well understood. This national inpatient analysis examines whether the severity of obesity worsens clinical and economic outcomes in tracheostomy patients. Methods: Using the National Readmission Database (NRD)-2022, we identified adult tracheostomy patients through ICD-10 codes. Then stratified into moderate obesity (BMI 30-39.9) and morbid obesity (BMI ≥40) groups. Primary Outcomes included complications (hemorrhage, stenosis, device issues), inpatient mortality, length of hospital stay (LOS), hospitalization costs, and 30- and 90-day readmission. Multivariable regression compared groups, with obese patients as the reference. Statistical significance was set at p< 0.05. Results: We identified 24,887 adult tracheostomy procedures. The tracheostomy rate was 0.19% (n=2,459) in morbidly obese vs 0.14% (n=2,088) in moderately obese patients. Post-tracheostomy complication rates differed between groups. Morbidly obese patients had higher rates of hemorrhage (59.6% vs 40.4%; p=0.001) and stenosis (62.9% vs 37.1%; p< 0.001), while obese patients had more device-related issues (68.8% vs 31.2%; p< 0.001) and respiratory complications (58.2% vs 41.8%; p< 0.001). Displacement rates were similar (50.6% vs 49.4%; p=0.042). Inpatient mortality was comparable (19.3% vs 17.9%; p=0.21). Morbidly obese patients had slightly longer stays (36 vs 35 days; p=0.007), with regression showing an adjusted increase of 2.3 days (p=0.028). No significant differences were noted in median costs (~$648K) or 30-/90-day readmission rates (p>0.05). Conclusions: Our study showed that morbidly obese patients (BMI≥40) undergoing tracheostomy face higher complication risks (hemorrhage/stenosis) than obese patients (BMI 30-39.9), but similar mortality, costs, and readmission rates. While procedural challenges differ, outcomes do not worsen significantly with increasing obesity severity. These results support the use of standardized tracheostomy protocols for all obese patients, with tailored prevention for BMI-specific complications.