Regional differences of tracheostomy in extremely premature neonates across the United States.

Abstract

To identify regional differences in tracheostomy rates and mortality in extremely premature neonates. The 1997-2019 Kids' Inpatient Databases (KID) were queried to identify children who completed 27 weeks gestation (27-wk) or less and 23 weeks gestation (23-wk) or less. Multivariable logistic regressions compared odds of tracheostomy and mortality by region (Midwest (MW), Northeast (NE), South (S), and West (W)) while controlling for demographic variables and comorbidities. Trend analyses were performed using Poisson Regressions. There were 2433 27-wk or less infants and 259 23-wk or less who received a tracheostomy. The MW was the only region where higher odds of tracheostomy were seen for 27-wk or less (aOR 1.25 [95%CI 1.12-1.39]) and 23-wk or less (aOR 1.68 [95%CI 1.24-2.27]) neonates when compared to all other regions combined. The S and MW had the highest increase in tracheostomy rates of 27-wk or less (β=5.1, r=0.77, p=0.025; β=3.8, r=0.93, p=0.001), and the MW had the highest increased rate of tracheostomy for 23-wk or less (β=1.9, r=0.97, p=0.008). There were no higher mortality odds by region in 27-wk or less. Mortality was the highest in the S for 23-wk or less (20.8%, p=0.015). This study identified regional differences in tracheostomy rates in extremely premature infants. Extremely premature neonates in the MW had higher odds of receiving a tracheostomy with comparable mortality rates to other regions. Further research is needed to analyze regional practice differences that may impact the decision to perform a tracheostomy.