RESUMO
OBJECTIVE: To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients. STUDY DESIGN: A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology-Head and Neck Surgery. SETTING: All tracheostomies were performed at a single tertiary care center. METHODS: Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications. RESULTS: A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients (P = .016). CONCLUSION: Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.
RESUMO
earlier identification has increased the number of infants identified with hearing loss. A significant and growing proportion of children who are D/deaf or hard of hearing have a disability (DWD). Literature related to infants and toddlers who are DWD is scarce because of the heterogeneity of the population and because many disabilities may go undiagnosed until a child is older. Service availability, professional preparation, and use of evidence-based practices must improve to best meet the needs of these children and their families. An examination of theory, research, and practice in early intervention for children who are DWD revealed a lack of qualified professionals and a need for targeted instruction in teacher preparation programs and for technological advances paired with treatment (e.g., telepractice). Increased transdisciplinary collaboration and technology utilization in teacher preparation hold promise as ways of improving service provision to young children who are DWD.
