Assistant Professor University of Texas Southwestern Medical Center/Children's Health Dallas
Objective: To determine whether social disadvantage (e.g., housing, income, education, employment) impacts outcomes after open airway surgery among pediatric patients.
Methods: A case series included all expansion open airway procedures at a tertiary stand-alone children's hospital between 2010 and 2018. The patients' primary zip codes of residence determined the Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure, and children were grouped based on less or more community disadvantage. Primary outcomes included complication and decannulation rates.
Results: Eighty-four procedures were included with 69% (58/84) double-stage reconstructions and 31% (26/84) single-stage reconstructions. The mean age at surgery was 4.1 years (SD: 3.8), 56% (47/84) were male, and the mean gestational age was 26.6 (SD: 3.5) weeks. Children from more disadvantaged communities represented 67% (56/84) of the surgeries. Children from more disadvantaged communities were more likely to have higher grade stenosis (89% vs. 64%, P=.008). They underwent similar rates of double stage procedures (73% vs. 61%, P=.24) compared to children from communities of lower disadvantage. Postoperative airway complications (20% vs. 18%, P=.84), non-airway complications (14% vs. 18%, P=.67), the total length of admission (8.1 vs. 11.3 days, P=.09), and need for more than four surveillance bronchoscopies (58% vs. 56%, P=.22) were not impacted by ADI grouping. While children from higher community disadvantage were just as likely to be decannulated after double stage surgeries (71% vs. 76%, P=.66), it more often took longer than six months to achieve (90% vs. 54%, P=.009).
Conclusions: Community disadvantage is associated with higher grade airway stenosis and extended durations between reconstruction and successful decannulation in children requiring expansion airway surgery. In contrast, ADI grouping did not impact complication and decannulation rates. Continued work is needed to understand how socioeconomic metrics influence pediatric open airway surgery.