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Impact of Race in the Tracheostomy Decision Making Process
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A1460 - Impact of Race in the Tracheostomy Decision Making Process
Author Block: N. Mesfin1, M. Vashi2, J. A. Greenberg3; 1Internal Medicine, Rush University Medical Center, Chicago, IL, United States, 2Rush University Medical Center, chicago, IL, United States, 3Rush University Medical Center, Chicago, IL, United States.
Rationale: Racial and socioeconomic disparities exist in the care of critically ill patients. Prior investigators have demonstrated racial and socioeconomic differences with respect to the timing of tracheostomy placement, which could have implications for weaning duration and risk of ventilator-associated pneumonia. We sought to determine whether there was an association between specific aspects related to the timing of tracheostomy placement and the patient’s racial background at a single urban academic medical center.
Methods: The medical records of all patients who received tracheostomies for acute respiratory failure at Rush University Medical Center from 2011-2015 were retrospectively reviewed. Patients were grouped based on the number of days from intubation to tracheostomy (≤7 days and >7 days). Patients who received mechanical ventilation for > 7 days prior to tracheostomy were also categorized based on the presence or absence of a passed spontaneous breathing trial (SBT) or extubation attempt. In addition, key dates in the tracheostomy decision process were recorded. The objective was to determine whether these variables were associated with a patient’s racial background.
Results: There were 372 patients with tracheostomies. There were 158 white, 166 black, and 48 other race. There were 115 patients with intubation to tracheostomy ≤ 7 days and 257 patients with intubation to tracheostomy > 7 days. Racial group was not associated with duration of mechanical ventilation prior to tracheostomy (p>0.05). Of the patients who received mechanical ventilation for > 7 days prior to tracheostomy, 29% never passed an SBT, 36% passed an SBT but were not extubated, and 35% were extubated at least once. There were no racial differences between these groups (p>0.05). The average time from intubation to tracheostomy mention by primary physician was 6.1 days (SD = 4.3), tracheostomy mention to family discussion was 1.6 days (SD = 2.2), discussion to consent was 2.3 days (SD = 3.7), and consent to surgery was 3.1 days (SD = 2.7). There were no significant differences within each time frame between racial backgrounds (p>0.05).
Conclusion: There was no association between any patient characteristic related to the timing of tracheostomy placement and racial background at a single center. As patients who receive tracheostomies are extremely heterogeneous, any apparent racial disparity that appears to exist requires a more detailed examination.
Author Block: N. Mesfin1, M. Vashi2, J. A. Greenberg3; 1Internal Medicine, Rush University Medical Center, Chicago, IL, United States, 2Rush University Medical Center, chicago, IL, United States, 3Rush University Medical Center, Chicago, IL, United States.
Rationale: Racial and socioeconomic disparities exist in the care of critically ill patients. Prior investigators have demonstrated racial and socioeconomic differences with respect to the timing of tracheostomy placement, which could have implications for weaning duration and risk of ventilator-associated pneumonia. We sought to determine whether there was an association between specific aspects related to the timing of tracheostomy placement and the patient’s racial background at a single urban academic medical center.
Methods: The medical records of all patients who received tracheostomies for acute respiratory failure at Rush University Medical Center from 2011-2015 were retrospectively reviewed. Patients were grouped based on the number of days from intubation to tracheostomy (≤7 days and >7 days). Patients who received mechanical ventilation for > 7 days prior to tracheostomy were also categorized based on the presence or absence of a passed spontaneous breathing trial (SBT) or extubation attempt. In addition, key dates in the tracheostomy decision process were recorded. The objective was to determine whether these variables were associated with a patient’s racial background.
Results: There were 372 patients with tracheostomies. There were 158 white, 166 black, and 48 other race. There were 115 patients with intubation to tracheostomy ≤ 7 days and 257 patients with intubation to tracheostomy > 7 days. Racial group was not associated with duration of mechanical ventilation prior to tracheostomy (p>0.05). Of the patients who received mechanical ventilation for > 7 days prior to tracheostomy, 29% never passed an SBT, 36% passed an SBT but were not extubated, and 35% were extubated at least once. There were no racial differences between these groups (p>0.05). The average time from intubation to tracheostomy mention by primary physician was 6.1 days (SD = 4.3), tracheostomy mention to family discussion was 1.6 days (SD = 2.2), discussion to consent was 2.3 days (SD = 3.7), and consent to surgery was 3.1 days (SD = 2.7). There were no significant differences within each time frame between racial backgrounds (p>0.05).
Conclusion: There was no association between any patient characteristic related to the timing of tracheostomy placement and racial background at a single center. As patients who receive tracheostomies are extremely heterogeneous, any apparent racial disparity that appears to exist requires a more detailed examination.
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