Contemporary Sociodemographic Disparities in Tracheostomy Timing and Resource Utilization

Disparities in tracheostomy outcomes are well described, but contemporary national trends in procedural timing and resource utilization remain unclear. This study evaluates racial differences in tracheostomy outcomes and temporal trends from 2018 to 2022 in a large national cohort during a period of significant healthcare system strain.

A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project National Inpatient Sample (2018-2022). Adult patients undergoing tracheostomy were included. Outcomes included length of stay (LOS), total hospital charges, in-hospital mortality, and time from admission to tracheostomy. Multivariable regression adjusted for demographic, socioeconomic, hospital-level, procedural, and Elixhauser comorbidity covariates to account for illness severity and case-mix.

Among 488,745 admissions (55.6% White, 20.7% Black, and 12.2% Hispanic), LOS, charges, and time to tracheostomy increased across all groups over time (all p < 0.001). Compared with White patients, Black and Hispanic patients had longer LOS (+2.26 and +2.94 days), higher charges, and longer admission-to-tracheostomy intervals (+0.73 and +1.06 days) (all p < 0.01). Disparities remained stable for Black patients but widened for Hispanic patients over time. In-hospital mortality differed by race, with lower odds among Black patients (OR: 0.93; p = 0.001) and higher odds among Hispanic patients (OR: 1.12; p < 0.001).

Racial disparities in tracheostomy timing and resource utilization persist in contemporary practice, with widening inequities among Hispanic patients. These findings highlight persistent disparities in tracheostomy timing and resource utilization and support further evaluation of factors influencing airway management.