Investigator University of Pennsylvania, United States
Introduction: There are multiple known factors, such as Mallampati Class III or higher, small mouth opening, and short thyromental distance, that put patients at an increased risk for difficult intubation. When intubating these patients, sometimes intubation is unsuccessful and the medical team must rely on other methods to help ventilate and oxygenate the patient. Our study aims to evaluate the effects of race on mortality, length of stay, and total charges in patients who ended up having failed intubations.
Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify adults with the ICD-10 diagnostic/procedural codes for failed or difficult intubation. Multivariate logistic regression analysis was used to obtain the odds ratios (OR) of inpatient mortality. Multivariate linear regression was used to determine the average length of hospital stay (LOS) and average total hospitalization charges (TOTCHG) with respect to race. Weighted analysis using Stata 17 MP was performed.
Results: A total of 4,459 adult patients were identified to have failed intubation, of which 618 died.
We found that Hispanics (OR 1.56, p< 0.05, CI 1.19 - 2.06), and Asians (OR 1.69, p< 0.05, CI 1.04 - 2.77), have a higher mortality rate, assuming the same age, gender and Charlson Comorbidity Index (CCI). There was no significant difference in mortality for all other minorities.
Furthermore, Black (+0.92 days, p< 0.05, CI 0.09 - 1.74), Hispanic (+2.31 days, p< 0.05, CI 0.94 - 3.68), and Native American (+4.21 days, p< 0.05, CI 1.79 - 6.63) patients were found to have an increased average LOS. TOTCHG were significantly higher with Hispanics (+$56,684.41, p< 0.05, CI 32,150.99 - 81,217.82), and Asian/Pacific Islanders (+$89,726.23, p< 0.05, CI 36,533.30 - 142919.20).
Conclusions: When controlling for age, sex, and CCI, our study showed that the Hispanic and Asian populations have higher average TOTCHG and more than 1.5x increased mortality due to failed intubation compared to that of white patients. Furthermore, Black, Hispanic, and Native Americans had longer LOS compared to that of white patients.Further studies are warranted to investigate the underlying cause of these disparities to improve clinical outcomes for these patients.
