Indigenous Status and Outcomes in Deep Neck Space Infections: An ICU Cohort Study

Deep neck space infections (DNSIs) present ongoing challenges to all clinicians, from physicians to surgeons. While several risk factors for adverse outcomes have been well established, to our knowledge, this is the first study to link Indigenous status directly to DNSI outcomes. We performed a retrospective cohort analysis of 351 adult patients with DNSIs who were admitted to the intensive care unit (ICU) at a South Australian quaternary centre between 2018 and 2024. We assessed outcomes such as hospital length of stay (LOS), 30-day readmission rates, and returns to the theater. We had a particular emphasis on Indigenous status and socioeconomic status.

Multivariable linear regressions were performed to analyse the primary outcome of Hospital LOS identifying several associations with adverse DNSI outcomes. Indigenous status was self-identified by patients to be Aboriginal and/or Torres Strait Islander. Socioeconomic disparities were characterized using the Socioeconomic index for areas (SEIFA) deciles.

Aboriginal and Torres Strait Islander patients had markedly longer hospital stays (adjusted mean ratio, 1.41; 95% CI, 1.10-1.81; p = 0.0073) and a more than five-fold increase in readmission rates (OR, 5.59; 95% CI, 1.55-20.19; p = 0.0086) compared to nonindigenous patients. Each 10-year increase in age was associated with a 6% rise in the mean LOS (p = 0.0038), and each single unit increase in glucose level correlated with a 3% increase in LOS (p = 0.0077).

These findings underscore the importance of incorporating demographic variables such as Indigenous status, alongside clinical parameters, in DNSI risk stratification and management. The literature addressing the influence of Indigenous status in surgical outcomes, particularly in DNSIs, remains limited. We advocate for further prospective observational studies and the development of care models co-designed with Indigenous patients and healthcare professionals as key stakeholders, with the goal of narrowing persistent disparities across Australian healthcare.