Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

Beams, Dylan R; Chorney, Stephen R.; Kou, Yann‐Fuu; Teplitzky, Taylor B.; Wynings, Erin M.; Johnson, Romaine F.

doi:10.1002/lary.30416

Cited by 6 publications

(10 citation statements)

References 43 publications

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“…These impacts manifest as patients and their families navigate challenges associated with medical equipment, physician visits, financial responsibilities, and potential complications such as infections that may necessitate readmission. 4,13,25 In order to improve care for this vulnerable population, physicians should recognize how social determinants of health can impact outcomes. Further studies examining these factors will be beneficial when managing BPD patients with a tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…This dataset has been used previously to publish work related to perioperative outcomes, socioeconomic and racial disparities, as well as tracheostomy caregiver quality of life. [24][25][26][27] CHAMP is therefore well-suited to explore longterm outcomes after tracheostomy surgery in children with BPD. The primary objective of this study is to examine the relationship between the presence of BPD and pulmonary hypertension with a patient's time to ventilator liberation as well as eventual decannulation.…”

Section: Introductionmentioning

confidence: 99%

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Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Johnson,

Beams,

Nadar

et al. 2024

Preprint

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Objectives: To determine the time to ventilator liberation and decannulation after tracheostomy placement in children with bronchopulmonary dysplasia (BPD) and pulmonary hypertension. Methods: A prospective cohort study included all children (<18 years old) who underwent tracheostomy between 2015 and 2021 with or without a diagnosis of BPD. The primary outcome measures were times to mechanical ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place. Patient demographics, associated comorbidities, and outcomes were compared between groups. Results: A total of 318 children met inclusion with a median (interquartile, IQR) age at tracheostomy of 6.9 (IQR: 4.1 – 49.2) months and 54% (N=170) were male. A diagnosis of BPD was made for 43% (N=136) and this group was younger at tracheostomy placement (5.2 vs. 24.5 months, P<.001) and more often had pulmonary hypertension (65% vs. 24%, P<.001) than children without BPD. Children with BPD spent a median of 2.92 years (IQR: 1.60 – 4.03) on mechanical ventilation compared to 1.84 years (IQR: 0.84 – 3.60) for children without BPD ( P=.003). Unadjusted estimation of time to decannulation was longer for children with BPD (HR=0.92, 95% CI: 0.62 – 1.38). The adjusted survival analysis for time to mortality included pulmonary hypertension as a variable of significance (aHR= 2.5, 95% CI: 1.43 – 4.40). Conclusion: The presence of BPD is associated with an increased duration of mechanical ventilation and time to tracheostomy decannulation. Pulmonary hypertension is associated with an increased mortality risk among this vulnerable population of children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Johnson,

Beams,

Nadar

et al. 2024

Preprint

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“…Moreover, the survival to discharge rate in the patients who underwent tracheostomies during their NICU stays was higher than those who did not (75% vs. 45%), indicating that tracheostomies may contribute to respiratory stabilization for home medical care. Children with medical devices, including a tracheostomy, however, do require careful follow‐up, significant medical support at home, emergency department visits, and possible hospital readmissions (Beams et al, 2022; Berry et al, 2017). Particularly, patients with long‐term tracheostomies have additional risks of life‐threatening adverse events such as tracheostomy tube obstruction, accidental decannulation, and tracheoinnominate artery fistula (Watters, 2017).…”

Section: Discussionmentioning

confidence: 99%

Impact of tracheostomies on the long‐term survival of patients with trisomy 13 syndrome

Tamaki,

Iwatani,

Hagimoto

et al. 2023

American J of Med Genetics Pt A

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In this retrospective cohort study, we investigated the impact of tracheostomies on the long‐term survival of children with trisomy 13 syndrome at a Japanese tertiary pediatric center. We compared survival and survival to discharge rates between patients who underwent tracheostomies during their NICU stays (T group, n = 8) and those who did not (non‐T group, n = 11). A total of 19 patients enrolled. Median survival in all patients was 673 (266–1535) days. Significant differences in the 1‐, 2‐, and 3‐year survival rates were found between the T and the non‐T groups (100% vs. 46%, p = 0.018; 88% vs. 18%, p = 0.006; 63% vs. 9%, p = 0.041, respectively). The survival to discharge rate was higher in the T versus non‐T group (75% vs. 45%, p = 0.352). This study highlights a significantly higher long‐term survival of patients with trisomy 13 syndrome who underwent tracheostomies during their NICU stays.

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“…5 While a tracheostomy is in place, children may necessitate frequent hospital readmissions. [6][7][8][9][10] They also require health care services such as elective surgeries, speech and language therapy, physical and occupational therapy, and routine follow-up visits. Despite the high utilization, limited research has been performed on the economic cost of pediatric tracheostomy beyond the initial few years.…”

mentioning

confidence: 99%

“…While a tracheostomy is in place, children may necessitate frequent hospital readmissions 6‐10 . They also require health care services such as elective surgeries, speech and language therapy, physical and occupational therapy, and routine follow‐up visits.…”

mentioning

confidence: 99%

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

Zhang,

Liu,

Narayanan

et al. 2024

OTO Open

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ObjectiveThis study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.Study DesignProspective analysis.SettingAcademic children's hospital.MethodsCosts associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges‐to‐costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders.ResultsA total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow‐up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions.ConclusionPediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.

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Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

Cited by 6 publications

References 43 publications

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Impact of tracheostomies on the long‐term survival of patients with trisomy 13 syndrome

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

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