Racial Influences on Pediatric Tracheostomy Outcomes

Objectives/Hypothesis: To determine the impact of race on outcomes after pediatric tracheostomy. Study Design: Retrospective case series. Methods: A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. Results: A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P =.005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P =.007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P =.002). Hispanic compared to Black children had higher median birth weight (2,529 g, P <.001), less extreme prematurity (44%, P <.001), and less BPD (21%, P =.04). The proportion of Black children was higher (30% vs. 19%, P <.001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P =.003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P =.51), decannulation (P =.17), or death (P =.92) after controlling for age, sex, prematurity, and ventilator dependence. Conclusion: Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long-term outcomes after pediatric tracheostomy. Laryngoscope, 132:1118–1124, 2022.