TY - JOUR

T1 - High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database

AU - Lundstrøm, Lars H

AU - Møller, Ann M

AU - Rosenstock, Charlotte

AU - Astrup, Grethe

AU - Wetterslev, Jørn

AU - Lundstrøm, Lars H

AU - Møller, Ann M

AU - Rosenstock, Charlotte

AU - Astrup, Grethe

AU - Wetterslev, Jørn

N1 - Keywords: Analysis of Variance; Body Height; Body Mass Index; Body Weight; Databases, Factual; Denmark; Female; Humans; Intraoperative Complications; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Neuromuscular Blockade; Obesity; Overweight; Predictive Value of Tests; Prospective Studies; ROC Curve; Regression Analysis; Risk Factors; Sample Size; Treatment Failure

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Previous studies have failed to detect high body mass index (BMI) as a risk factor for difficult tracheal intubation (DTI). BMI was investigated as a risk factor for DTI in patients planned for direct laryngoscopy. METHODS: A cohort of 91,332 consecutive patients planned for intubation by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use of neuromuscular blocker, and BMI were retrieved. Logistic regression to assess whether BMI was associated with DTI was performed. RESULTS: The frequency of DTI was 5.2% (95% confidence interval [CI] 5.0-5.3). In multivariate analyses adjusted for other significant covariates, BMI of 35 or more was a risk for DTI with an odds ratio of 1.34 (95% CI 1.19-1.51, P < 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an odds ratio of 1.031 (95% CI 1.002-1.061, P < 0.04). CONCLUSIONS: High BMI is a weak but statistically significant predictor of difficult and failed intubation and may be more appropriate than weight in multivariate models of prediction of DTI.

AB - BACKGROUND: Previous studies have failed to detect high body mass index (BMI) as a risk factor for difficult tracheal intubation (DTI). BMI was investigated as a risk factor for DTI in patients planned for direct laryngoscopy. METHODS: A cohort of 91,332 consecutive patients planned for intubation by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use of neuromuscular blocker, and BMI were retrieved. Logistic regression to assess whether BMI was associated with DTI was performed. RESULTS: The frequency of DTI was 5.2% (95% confidence interval [CI] 5.0-5.3). In multivariate analyses adjusted for other significant covariates, BMI of 35 or more was a risk for DTI with an odds ratio of 1.34 (95% CI 1.19-1.51, P < 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an odds ratio of 1.031 (95% CI 1.002-1.061, P < 0.04). CONCLUSIONS: High BMI is a weak but statistically significant predictor of difficult and failed intubation and may be more appropriate than weight in multivariate models of prediction of DTI.

U2 - 10.1097/ALN.0b013e318194cac8

DO - 10.1097/ALN.0b013e318194cac8

M3 - Journal article

C2 - 19194154

VL - 110

SP - 266

EP - 274

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -