Social Capital and Pediatric Tracheostomy Outcomes

Abstract

Objective: To determine pediatric tracheostomy outcomes by social capital as measured through economic connectedness (EC). Methods: A retrospective cohort of patients (< 18 years) who underwent tracheostomy at a tertiary pediatric hospital between 2009 and 2020 was divided into high and low socioeconomic status (SES) groups based on their neighborhood-level EC. This metric of social capital determines the degree to which an individual is connected to families of higher SES based on zip code. Regression analysis determined associations between EC and adverse outcomes, decannulation, and mortality. Results: A total of 527 patients were included, with 79 (15%) having higher EC and 448 (85%) having lower EC. The groups had similar medical complexity and comorbidities, and EC was found to correlate with other metrics of SES including poverty rate and area deprivation index (ADI) by zip code (p < 0.001). Patients with low EC were more likely to be discharged to an outside facility than high EC patients (9.3% vs. 3.8%, p = 0.04). Outcome analysis revealed no significant differences in decannulation (22% vs. 32%, p = 0.07), mortality (22% vs. 21%, p = 0.88), or readmission rate (19% vs. 19%, p = 0.95). Conclusions: EC does not correlate with adverse outcomes, mortality, or decannulation for pediatric tracheostomy patients. These findings suggest that EC may not be the primary component of social capital that influences perioperative challenges and long-term outcomes for pediatric tracheostomies in this study population.