Successful Tracheostomy Decannulation: Why Body Mass Index Alone Is Not Enough

Background Obesity is increasingly common among critically ill patients. The association between body mass index and outcomes of tracheostomy including eventual decannulation are not well understood. This study aimed to evaluate whether body mass index (BMI) is associated with time to tracheostomy decannulation among surgical critical care patients undergoing tracheostomy. We hypothesized that increasing BMI would be associated with longer duration from tracheostomy placement to decannulation in surgical patients. Methods Adult participants undergoing tracheostomy creation by the general surgery services at a single academic center from April 2018 through December 2022 were retrospectively evaluated. Outcomes were analyzed by obesity status (BMI > 30 kg/m 2 ) and BMI classification, with associations assessed by Wilcoxon rank-sum analysis, Spearman rank correlation, and Kaplan–Meier analysis. Results A total of 385 participants were included for analysis. Obesity was associated with a longer duration of endotracheal intubation (10.4 ± 6.5 vs 12.1 ± 6.4 days, P = 0.002) prior to tracheostomy creation. Among the 275 participants who achieved decannulation, there was no significant difference in time to decannulation between obese (BMI ≥ 30) and non-obese (BMI < 30) (χ 2 = 1.74, df = 1, P = 0.19) or when stratified by BMI category (χ 2 = 4.30, df = 5, P = 0.51). Discussion Although BMI was associated with delayed tracheostomy creation, BMI was not associated with prolonged tracheostomy dependence. Within contemporary decannulation practice, successful tracheostomy liberation appears to be driven by broader factors including disease severity, neurologic recovery, respiratory physiology, and multidisciplinary assessment of decannulation readiness.