Contemporary Sociodemographic Disparities in Tracheostomy Timing and Resource Utilization

Area of Science:

• Health Services Research
• Health Equity
• Surgical Outcomes

Background:

• Tracheostomy outcomes show documented racial disparities.
• Contemporary national trends in tracheostomy timing and resource use are not well understood.
• Healthcare systems faced significant strain from 2018-2022.

Purpose of the Study:

• To evaluate racial differences in tracheostomy outcomes.
• To analyze national trends in tracheostomy timing and resource utilization from 2018-2022.
• To assess disparities during a period of healthcare system strain.

Main Methods:

• Retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample (2018-2022).
• Included adult patients undergoing tracheostomy.
• Analyzed length of stay (LOS), total hospital charges, in-hospital mortality, and time from admission to tracheostomy.
• Used multivariable regression to adjust for patient, hospital, and procedural factors.

Main Results:

• Across 488,745 admissions, LOS, charges, and time to tracheostomy increased over time for all racial groups (p < 0.001).
• Black and Hispanic patients had longer LOS (+2.26 and +2.94 days, respectively) and longer admission-to-tracheostomy intervals (+0.73 and +1.06 days, respectively) compared to White patients (p < 0.01).
• Disparities remained stable for Black patients but widened for Hispanic patients. In-hospital mortality was lower for Black patients (OR: 0.93) and higher for Hispanic patients (OR: 1.12).

Conclusions:

• Persistent racial disparities in tracheostomy timing and resource utilization exist.
• Widening inequities were observed among Hispanic patients.
• Further evaluation of factors influencing airway management is warranted to address these disparities.