Assistant Professor Marshall University School of Medicine
Introduction: Rural patients are at risk for worse health outcomes than their nonrural counterparts, which may extend to tracheostomy-related outcomes. The purpose of this study was to determine if there is a difference in decannulation rates between rural and non-rural children.
Methods: This retrospective study evaluated decannulation rates among patients in the 50-hospital Pediatric Health Information System (PHIS) Database who underwent tracheostomy from 2013-2017. Rural urban commuting area codes designate rural and nonrural status. A hazard analysis was employed to adjust for potential bias associated with variable lengths of follow-up. A Cox proportional hazards regression model was used to examine for differences in decannulation rates by rurality.
Results: There were 98,593 children included in the analysis. Mean age at tracheostomy was 2.4 years (SD=2.3). Mean length of follow-up was 686 days (SD=538). Over half (57%) of the children were male and 58% were white race. Two thirds (68%) were publicly insured and 53% were ventilator-dependent. Rural children were 34% less likely than non-rural children to decannulate over time (CI 26-41%, p<0.001), adjusted for age, race, sex, insurance status and ventilator-dependence.
Conclusion: Rural pediatric tracheostomy patients were less likely to decannulate than nonrural patients during the study period.