Fellow University of California San Francisco University of California San Francisco San Francisco, California, United States
Background: Children with bronchopulmonary dysplasia (BPD) often require interventions such as tracheostomy insertion and chronic ventilation in the neonatal period. There is little evidence to guide care of these patients as they age, especially regarding when and how to wean and eventually decannulate the tracheostomy. Race and socioeconomic status have been variably shown to relate to age at decannulation in BPD patients in single center studies.
Objective: To describe the demographic and clinical characteristics of tracheostomy-dependent BPD patients in a nation-wide database and to assess for differences in age at decannulation between racial and ethnic groups.
Design/Methods: Data from over 700 hospitals was obtained from the Vizient Clinical Data Base. Admissions of patients <18 years old with a diagnosis of BPD were queried between 10/1/2016 and 10/1/2020. Rates of tracheostomy insertion and decannulation were determined from international classification of disease 9 and 10 procedure codes. The demographic profiles of the tracheostomy-dependent and tracheostomy-decannulated cohorts were described and differences in age at decannulation were compared between racial and ethnic groups using linear regression modeling.
Results: There were 39,509 admissions of 29,582 patients with BPD during the study period. 2,532 BPD patients had a tracheostomy (8.6%); 40.5% of those patients were Non-Hispanic White (NHW) and 32.1% were Non-Hispanic Black (NHB, Table 1). 124 were decannulated during the 4-year span (4.9%) at a median age of 34.0 months (IQR 26.0-47.5). Compared to NHW patients, NHB patients were decannulated at an older age (32.5 versus 35.5 months, p = 0.025; Table 2, Figure 1). Hispanic and Asian patients were decannulated at a median of 35 and 42 months, respectively, however, this was not statistically significantly different from NHW children (Table 2). Conclusion(s): Nationwide data reveals an average age at decannulation of around 3.4 years for BPD patients with a tracheostomy. Decannulation occurs at an older age for NHB children compared to NHW. This is a potentially important health care disparity and further investigation is merited to assess the clinical factors that weigh into the decision to decannulate in this population.
Table 1: Demographic profiles of tracheostomy-dependent and tracheostomy-decannulated patients
Table 2: Median age at tracheostomy decannulation
Figure 1: Age at tracheostomy decannulation by race/ethnicity
Authors/Institutions: Michael Smith, University of California San Francisco, San Francisco, California, United States; Duncan Henry, University of California San Francisco, San Francisco, California, United States; Malini Mahendra, University of California San Francisco, San Francisco, California, United States; Martina A. Steurer, UCSF, University of California San Francisco, San Francisco, CA, US, academic, San Francisco, California, United States