(0226) Impact of Social Determinants of Health on Tracheostomy Placement in the NICU Population

Introduction: Social determinants of health have been shown to affect access to healthcare and treatment outcomes in a variety of populations and healthcare settings. This study aims to examine the practices and outcomes surrounding the decision to perform tracheostomy for patients in the neonatal intensive care unit (NICU).

Methods: International Review board approval was obtained to perform retrospective review of NICU patients who underwent tracheostomy from 2018-2023. Patient birth history, demographics, age, race/ethnicity, primary language, insurance type, ZIP code, surgical indication, and comorbid conditions were collected. Full data including the time between admission, intubation, consult, surgery, and follow up were analyzed. The primary outcome was difference in time measures. Kruskall Wallis test and Pearson’s Correlation coefficient were used for statistical analysis.

Results: A total of 112 pediatric patients were included in the study. Length of stay was greater for the extremely pre-term group (p = 0.04661), extremely low birth weight (0.00011), and non-syndromic infants (0.00191). Loss of upper airway was consistent with faster time to trach placement (p = 0.00121). Greater length of stay prior to trach placement was observed in White patients (p = 0.03861), and Hispanic patients (p = 0.03941). Regardless of primary language, the length of stay prior to consult and length of stay post trach placement were not significant. Insurance status was not significant in regards to time to trach placement or length of stay.

Conclusions: Sex, language, and insurance status had no correlation with any of the outcomes reviewed. White and Hispanic patients had a greater length of stay prior to ENT consult for tracheostomy placement. Extremely premature, extremely low birth weight, and non-syndromic infants had a greater length of intubation and length of stay prior to ENT consult, while loss of upper airway was consistent with faster time to trach placement. There was no significant difference in 30-day readmission when compared to sex, race, ethnicity, weight, language, prematurity, indication, and insurance status.