Lukas S Fiedler, Tobias Meyer, Fabian Burk, Fynn Roters
Obesity and DM were associated with higher crude odds of clinically documented early peristomal wound infection following bedside surgical tracheostomy. Given the exploratory, unadjusted analyses and incomplete follow-up through days 10-14, these findings should be considered hypothesis-generating and require confirmation in larger prospective cohorts.
BACKGROUND: Obesity and diabetes mellitus (DM) are established risk factors for impaired wound healing, but their associations with early postoperative complications following surgical tracheostomy in critically ill patients remain insufficiently characterized. This study evaluated the associations of obesity and DM with clinically documented early peristomal wound infection following bedside surgical tracheostomy using either the Visor or Björk technique.
METHODS: This retrospective single-centre cohort study included 92 ICU patients who underwent bedside surgical tracheostomy between 2022 and 2023. Postoperative complications were retrospectively assessed from clinical documentation at postoperative days 5-7 and 10-14. Documentation at days 5-7 was available for all 92 patients, whereas documentation at days 10-14 was available for 78 patients. The analyses therefore evaluated complications documented during the available postoperative follow-up period of up to 14 days rather than complete 14-day cumulative incidence. Associations of obesity and DM with clinically documented peristomal wound infection were assessed using exploratory univariable analyses.
RESULTS: Clinically documented peristomal wound infection occurred in 18 of 92 patients (19.6%) during the available postoperative follow-up period. Infection was documented in 10 of 28 patients with obesity (35.7%) compared with 8 of 64 patients without obesity (12.5%; crude OR 3.89, 95% CI 1.33-11.35; Fisher's exact p = 0.020). Infection was also more frequent in patients with DM (12/31, 38.7%) than in those without DM (6/61, 9.8%; crude OR 5.79, 95% CI 1.91-17.57; Fisher's exact p = 0.002). Postoperative haemorrhage was numerically more frequent in patients with obesity (14.3% vs. 6.3%), but this association was not statistically significant (crude OR 2.50, 95% CI 0.58-10.78; Fisher's exact p = 0.242).
CONCLUSIONS: Obesity and DM were associated with higher crude odds of clinically documented early peristomal wound infection following bedside surgical tracheostomy. Given the exploratory, unadjusted analyses and incomplete follow-up through days 10-14, these findings should be considered hypothesis-generating and require confirmation in larger prospective cohorts.