Disparities in Posthospitalization Disposition Following Tracheotomy: A National Analysis.

Abstract

Objective: Previous studies have demonstrated the impact of sociodemographic factors on disease development, management, and outcomes in adult and pediatric populations. Given that postoperative management is key in reducing complications following a tracheotomy, we assessed the impact of sociodemographic factors on a patient's discharge disposition.

Study design: Cross-sectional study.

Setting: Health Care Utilization Project's (HCUP) National Inpatient Survey (NIS).

Methods: The HCUP NIS was queried for all patients undergoing tracheotomy between 2017 and 2021. All analyses were performed using R Version 4.3.1 survey procedures to account for strata and cluster effects.

Results: We identified 81,069 admissions during which a tracheotomy was performed and, after appropriate weighting for the HCUP NIS survey design, found that 15.1% of admissions resulted in routine discharge, 4.5% transferred to a short-term hospital, 52.3% transferred to a skilled nursing facility (SNF)/intermediate care facility (ICF)/other facility, 16.9% discharged with home health care. Admissions routinely discharged had the lowest median (interquartile range) age (48 [23, 61] years), whereas admissions resulting in death or transfer to a SNF/ICF/other facility type had the greatest age (63 [53, 70] years). On both univariable and multivariable analyses, age, race, sex, insurance type, geographic region, and hospital size were associated with discharge disposition.

Conclusion: Our study highlights that disparities exist among patient populations and were found in both unadjusted and adjusted analyses. Further attention and resource allocation for the care of patients with a tracheostomy may work toward identifying sources of disparity, which may be modified to improve patient care.