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The association of frailty with morbidity following surgical tracheostomy

Published online by Cambridge University Press:  27 March 2025

Eoin F. Cleere Open the ORCID record for Eoin F. Cleere [Opens in a new window] ,
Justin M. Hintze ,
Akash N. Ramesh ,
Isobel O’Riordan ,
Conrad V.I. Timon ,
John Kinsella ,
Paul Lennon  and
Conall W.R. Fitzgerald
Eoin F. Cleere*
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
Justin M. Hintze
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
Akash N. Ramesh
Affiliation:
School of Medicine, Trinity College Dublin, Dublin, Ireland
Isobel O’Riordan
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
Conrad V.I. Timon
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
John Kinsella
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
Paul Lennon
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
Conall W.R. Fitzgerald
Affiliation:
Department of Head and Neck Surgery, St James’s Hospital, Dublin, Ireland
*
Corresponding author: Eoin F. Cleere; Email: eoincleere@rcsi.ie
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Abstract

Objectives

This study aimed to assess whether frailty (measured using the 5-Item Modified Frailty Index) was associated with increased morbidity following surgical tracheostomy.

Methods

A single-centre retrospective cohort study analysed a prospectively maintained database between 2022 and 2023. Univariable and multivariable regressions were used to determine factors (including frailty) associated with increased morbidity.

Results

A total of 174 patients underwent surgical tracheostomy in the study period with 28 patients determined as frail (16.1 per cent). Overall, 21 patients (12.1 per cent) suffered a tracheostomy-specific complication. Multivariable regression found an association between frail patient status and increased tracheostomy-specific complications (odds ratio 4.09, 95 per cent confidence interval 1.51–11.11; p = 0.006) and longer hospital length of stay (β 15.76 days, 95 per cent confidence interval 1.06–30.44; p = 0.036).

Conclusion

Frailty was associated with increased morbidity and longer hospital stay following tracheostomy. Assessment of frailty may guide decision making and patient discussions when planning tracheostomy.

Keywords

tracheostomyfrailtyclassificationmorbiditytracheotomy
Type
Main Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 7
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Eoin F. Cleere takes responsibility for the integrity of the content of the paper

Presented at the Irish Head and Neck Society Conference, 12th April 2025, Kilkenny, Ireland

References

McGrath, BA, Brenner, MJ, Warrillow, SJ, Pandian, V, Arora, A, Cameron, TS, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med 2020;8:717–25Google Scholar
Cheung, NH, Napolitano, LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes + discussion Respir. Care 2014;59:895–919Google Scholar
Murray, M, Shen, C, Massey, B, Stadler, M, Zenga, J. Retrospective analysis of post-tracheostomy complications. Am J Otolaryngol 2022;43:103350Google Scholar
Jotic, AD, Milovanovic, JP, Trivic, AS, Folic, MM, Krejovic-Trivic, SB, Radin, ZZ, et al. Predictors of complications occurrence associated with emergency surgical tracheotomy. Otolaryngol Head Neck Surg 2021;164:346–52Google Scholar
Ruohoalho, J, Xin, G, Bäck, L, Aro, K, Tapiovaara, L. Tracheostomy complications in otorhinolaryngology are rare despite the critical airway. Eur Arch Otorhinolaryngol 2021;278:4519–23Google Scholar
Nakarada-Kordic, I, Patterson, N, Wrapson, J, Reay, SD. A systematic review of patient and caregiver experiences with a tracheostomy. Patient 2018;11:175–91Google Scholar
Brass, P, Hellmich, M, Ladra, A, Ladra, J, Wrzosek, A. Percutaneous techniques versus surgical techniques for tracheostomy. Cochrane Database Syst Rev 2016;(7):CD008045Google Scholar
Adly, A, Youssef, TA, El-Begermy, MM, Younis, HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol 2018;275:679–90Google Scholar
Kashlan, KN, Williams, AM, Chang, SS, Yaremchuk, KL, Mayerhoff, R. Analysis of patient factors associated with 30-day mortality after tracheostomy. Laryngoscope 2019;129:847–51Google Scholar
Baskin, JZ, Panagopoulos, G, Parks, C, Rothstein, S, Komisar, A. Clinical outcomes for the elderly patient receiving a tracheotomy. Head Neck 2004;26:71–5Google Scholar
Levy, L, Smiley, A, Latifi, R. Mortality risk factors in patients admitted with the primary diagnosis of tracheostomy complications: an analysis of 8026 patients. Int J Environ Res Public Health 2022;19:9031Google Scholar
Clegg, A, Young, J, Iliffe, S, Rikkert, MO, Rockwood, K. Frailty in elderly people. Lancet 2013;381:752–62Google Scholar
Welsh, TJ, Gordon, AL, Gladman, JR. Comprehensive geriatric assessment—a guide for the non-specialist. Int J Clin Pract 2014;68:290–3Google Scholar
Subramaniam, S, Aalberg, JJ, Soriano, RP, Divino, CM. New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data. J Am Coll Surg 2018;226:173–81.e8Google Scholar
Wilson, JM, Holzgrefe, RE, Staley, CA, Schenker, ML, Meals, CG. Use of a 5-Item Modified Frailty Index for risk stratification in patients undergoing surgical management of distal radius fractures. J Hand Surg Am 2018;43:701–9Google Scholar
Weaver, DJ, Malik, AT, Jain, N, Yu, E, Kim, J, Khan, SN. The Modified 5-Item Frailty Index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions. World Neurosurg 2019;124:e626–32Google Scholar
Tracy, BM, Wilson, JM, Smith, RN, Schenker, ML, Gelbard, RB. The 5-Item Modified Frailty Index predicts adverse outcomes in trauma. J Surg Res 2020;253:167–72Google Scholar
Chinta, S, Haleem, A, Sibala, DR, Kumar, KD, Pendyala, N, Aftab, OM, et al. Association between modified frailty index and postoperative outcomes of tracheostomies. Otolaryngol Head Neck Surg 2024;170:1307–13Google Scholar
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–8Google Scholar
Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51Google Scholar
Clavien, PA, Barkun, J, de Oliveira, ML, Vauthey, JN, Dindo, D, Schulick, RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–96Google Scholar
Walston, JD, Bandeen-Roche, K. Frailty: a tale of two concepts. BMC Med 2015;13:185Google Scholar
Cleere, EF, Davey, MG, O’Neill, JP. “Age is just a number”; frailty as a marker of peri-operative risk in head and neck surgery: systematic review and meta-analysis. Head Neck 2022;44:1927–39Google Scholar
Goshtasbi, K, Birkenbeuel, JL, Lehrich, BM, Abiri, A, Haidar, YM, Tjoa, T, et al. Association between 5-Item Modified Frailty Index and short-term outcomes in complex head and neck surgery. Otolaryngol Head Neck Surg 2022;166:482–9Google Scholar
Andriolo, BNG, Andriolo, RB, Saconato, H, Atallah, Á, Valente, O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015;(1):CD007271Google Scholar
Mallick, A, Bodenham, AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol 2010;27:676–82Google Scholar
Fogg, C, Fraser, SDS, Roderick, P, de Lusignan, S, Clegg, A, Brailsford, S, et al. The dynamics of frailty development and progression in older adults in primary care in England (2006–2017): a retrospective cohort profile. BMC Geriatr 2022;22:30Google Scholar
Piccirillo, JF, Vlahiotis, A, Barrett, LB, Flood, KL, Spitznagel, EL, Steyerberg, EW. The changing prevalence of comorbidity across the age spectrum. Crit Rev Oncol Hematol 2008;67:124–32Google Scholar
Wong, CH, Weiss, D, Sourial, N, Karunananthan, S, Quail, JM, Wolfson, C, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res 2010;22:54–62Google Scholar
Rohrmann, S. Epidemiology of frailty in older people. In: Veronese, N, ed. Advances in Experimental Medicine and Biology. Cham: Springer 2020;1216:21–7Google Scholar
Law, JA, Duggan, LV, Asselin, M, Baker, P, Crosby, E, Downey, A, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth 2021;68:1405–36Google Scholar
Brar, RS, Whitlock, RH, Komenda, PV, Rigatto, C, Prasad, B, Bohm, C, et al. Provider perception of frailty is associated with dialysis decision making in patients with advanced CKD. Clin J Am Soc Nephrol 2021;16:552–9Google Scholar
Filippova, OT, Tin, AL, Alonso, J, Vickers, AJ, Tew, WP, Gardner, GJ, et al. Frailty based on the memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer. Gynecol Oncol 2021;161:687–92Google Scholar
Gopalan, PD, Pershad, S. Decision-making in ICU – a systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions. J Crit Care 2019;50:99–110Google Scholar
Khatry, K, Peel, NM, Gray, L, Hubbard, RE. The utility of the frailty index in clinical decision making. J Frailty Aging 2018;7:138–41Google Scholar