The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes
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Published on: March 15, 2024
Kershena Liao1, Stephen R Chorney1,2, Ashley B Brown2
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Insights
Socioeconomic disadvantage is linked to longer hospital stays and higher costs for children undergoing tracheostomy. These disparities highlight the need for further research into equitable pediatric care.
Area of Science:
- Pediatric surgery
- Health services research
- Socioeconomic determinants of health
Background:
- Socioeconomic factors can influence healthcare access and outcomes.
- Understanding these disparities is crucial for improving pediatric surgical care.
- Tracheostomy in children is a significant intervention with potential for long-term impact.
Purpose of the Study:
- To investigate the association between socioeconomic disadvantage and perioperative outcomes in children undergoing tracheostomy.
- To identify specific outcomes affected by socioeconomic status in this pediatric population.
Main Methods:
- Retrospective case series of pediatric tracheostomy patients.
- Patients stratified into less and more disadvantaged groups using the Area Deprivation Index (ADI).
- Analysis of length of stay, total cost, in-hospital mortality, and 30-day readmission rates.
Main Results:
- Children from more disadvantaged communities experienced significantly longer median total length of stay (113 vs. 79 days) and higher median total costs ($461,000 vs. $279,000).
- Increased risk of prolonged hospitalizations was observed in children from more disadvantaged areas (HR=0.63).
- No significant differences were found in readmission rates, mortality, or quality of life scores between groups.
Conclusions:
- Community socioeconomic disadvantage is associated with prolonged hospitalizations and increased costs following pediatric tracheostomy.
- Health disparities significantly impact the efficiency and financial burden of care for children with tracheostomies.
- Further investigation is warranted to address how these disparities affect the safe and effective care of children requiring tracheostomies.
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.
Level Of Evidence:
4 Laryngoscope, 131:2603-2609, 2021.
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