Deep neck space infections (DNSIs) continue to challenge all medical practitioners from surgeons to physicians with its potentially life-threatening complications. While several risk factors for poor outcomes are recognized, the impact of Indigenous status on DNSI prognosis remains largely unexplored in the literature. This study aims to shed light on this critical gap, investigating the role of Indigenous status in DNSI outcomes within an Australian healthcare context. We conducted a comprehensive retrospective analysis of 300 adult DNSI patients treated at a South Australian quaternary centre from 2018 to 2024. Multivariate regression models were used to assess factors such as hospital length of stay (LOS), 30-day readmission rates, and returns to theatre with a particular focus on Indigenous status. Our findings revealed multiple factors involved with adverse outcomes in DNSI with Indigenous status in particular emerging as a powerful independent predictor. Indigenous patients experienced significantly longer hospital stays (adjusted mean ratio 1.41, 95% CI 1.10-1.81; p=0.0073) and more than five-fold increase in readmission (OR 5.59, 95% CI 1.55-20.19; p=0.0086) compared to non-Indigenous counterparts. Additionally, each decade increase in age corresponded to a 6% increase in mean LOS (p=0.0038), while each unit rise in glucose levels was associated with a 3% LOS increase (p=0.0077) we also assessed patients according to SEIFA Deciles to further characterise socio economic disparities independent of Indigenous status. Our findings have clear implications for clinical practice not least of which suggest that factors outside of traditional medical parameters such as Indigenous status should be a key consideration in DNSI risk stratification and management. There is a significant dearth in literature when addressing factors such as Indigenous status in surgery, even more so in DNSI’s. Such research aims to address health inequities and implement practical and effective tools to improve healthcare for all patients