The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

Abstract

Objectives: To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy. Methods: We performed a retrospective case series of children who underwent tracheostomy. Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in-hospital mortality, and 30-day all-cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.Results: A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48-0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.Conclusions: Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.

Racial Influences on Pediatric Tracheostomy Outcomes

“…Another important consideration is the interplay between socioeconomic status (SES) and risk factors associated with the need for tracheostomy (e.g., preterm birth). Our previous research showed that children who live in more disadvantaged communities represented a higher share of tracheostomy patients 24 . Interestingly, the prevalence of risk factors like preterm birth was similar between high‐ and low‐disadvantaged groups.…”

Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

“…1 Community disadvantage has been associated with differences in hospitalization length and costs after pediatric tracheostomy placement regardless of medical complexity. 12 The influence of socioeconomic forces in pediatric otolaryngology is gaining tremendous interest, 28 and a commitment to addressing these factors for pediatric tracheostomy patients is necessary. The current results suggest that among a cohort of children with a tracheostomy and high medical complexity, health disparities by language or ethnicity may have a modest influence on outcomes.…”

“…Tracheostomy-dependent children with community health disparities encounter longer hospitalization lengths and total costs regardless of medical complexity. 12 Some of these discharge obstacles could be language related, similar to those identified in discharges and readmissions after adenotonsillectomy. 13,14 As a result, recognizing barriers in the Spanish-speaking community may provide institutions with targets for tracheostomy-based quality improvement initiatives.…”

Pediatric Tracheostomy‐Related Complications: A Cross‐sectional Analysis

“…Published complication rates from single institutions after pediatric tracheostomy approach 50%, 7,34-37 with as many as 20% of events related specifically to the tracheostomy. 37-39 Among preterm infants, >60% develop tracheostomy-related complications such as skin breakdown, granulation, and tracheitis based on retrospective data from tertiary intuitions. 40 The results published here provide updated national estimates and offer an adequate sample size for infrequent events.…”