Indications, Hospital Course, and Complexity of Patients Undergoing Tracheostomy at a Tertiary Care Pediatric Hospital

Liu, Charles; Heffernan, Colleen; Saluja, Saurabh; Yuan, John; Paine, Melody; Oyemwense, Naomi; Berry, Jay G.; Roberson, David W.

doi:10.1177/0194599814531731

Cited by 60 publications

(69 citation statements)

References 20 publications

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“…These teams include the consultant services of otorhinolaryngologists, critical care specialists, neonatologists, pulmonologists, and general pediatricians, as well as the expertise of nurses, therapists, and equipment specialists. 1 On average, while hospitalized, these patients have 9.3 physician-led services and 4.3 non-physician-led services involved in their care. 1 Given their medical complexity, patients with tracheostomy are at increased risk for morbidity, including hospital readmissions.…”

Section: Introductionmentioning

confidence: 99%

“…1 On average, while hospitalized, these patients have 9.3 physician-led services and 4.3 non-physician-led services involved in their care. 1 Given their medical complexity, patients with tracheostomy are at increased risk for morbidity, including hospital readmissions. According to 2013 data from the Healthcare Cost and Utilization Project on tracheostomy placement in 7856 adults, nearly 23% of patients were readmitted within 30 days.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Mamey

Russell

2017

International Journal of Pediatric Otorhinolaryngology

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Objective To determine factors associated with post-tracheotomy hospital readmission within 30 days of discharge. Methods Children 18 years and younger who underwent tracheotomy at Children’s Hospital Los Angeles (CHLA) between 1/1/2005 and 12/31/2013 with at least 30 days of follow-up at CHLA were identified through ICD-9 procedure codes. Patient characteristics and covariates were obtained by linking manual chart review and administrative data. We used multivariate logistic regression to identify the independent association between risk factors and the primary outcome of 30-day all-cause same-hospital readmission. Results Of the 273 patients included, the median age at admission was 6 months [interquartile range (IQR): 1–51 months]. Among this primarily male (60.8%) and Hispanic (66.3%) cohort with a high proportion of discharge on positive pressure ventilation (47.1%), the 30-day readmission rate was 22% (n=60). Of the readmissions, 92% (n=55) were unplanned and 64% (n=35) were associated with acute respiratory illnesses. Multivariate regression analysis demonstrated that, among patients ≤ 12 months, discharge on positive pressure ventilation [adjusted odds ratio (aOR)=2.88, 95% confidence interval (CI)=1.19–6.97] was associated with increased odds of readmission, while gastrostomy tube placement during the tracheotomy hospitalization (aOR=0.42, 95% CI=0.19–0.96) and prematurity (aOR=0.35, 95% CI=0.15–0.83) were associated with decreased odds of readmission. In patients > 1 year of age, increased length of hospitalization (aOR=1.01 per hospital day, 95% CI=1–1.02) and presence of comorbid malignancy (aOR=6.03, 95% CI=1.25–29.16) were associated with increased odds of readmission. Conclusions Over one-fifth of children undergoing tracheotomy had an unplanned hospital readmission within 30 days after discharge. Because the majority of readmissions were unplanned and due to acute respiratory illnesses, future research should investigate how discharge procedures and improved care coordination may lower readmission rates in high-risk patients (e.g., patients discharged on positive pressure ventilation).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Mamey

Russell

2017

International Journal of Pediatric Otorhinolaryngology

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“…Most studies of children receiving tracheostomies or initiated on LTV have been from a single-institution (8–10) or focused on patients receiving tracheostomies (11–14). Previous studies often group patients that received tracheostomies together without differentiating those supported by IV or patients receiving LTV without differentiating those using IV and NIV.…”

Section: Introductionmentioning

confidence: 99%

Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs*

Edwards

Houtrow

Lucas

et al. 2016

Pediatric Critical Care Medicine

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Objectives To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in pediatric intensive care units (PICU), and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites. Design Retrospective cross-sectional analysis. Settings Seventy three North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Performance System. Patients PICU patients admitted between 2009 and 2011. Interventions None. Measurements and Main Results Among 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1034 received a tracheostomy only, 717 were initiated on invasive ventilation (IV), and 381 were initiated on noninvasive ventilation (NIV). Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging 0–4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of IV versus NIV. Conclusions While the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.

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“…Tracheostomy is increasingly performed in pediatric patients with chronic respiratory failure or complex airway disorders. Indications for tracheostomy continue to evolve, and it is commonly performed for the management of complex chronic conditions that necessitate prolonged mechanical ventilation, including chronic lung disease and neurological impairment . Tracheostomy may reduce the impact of long‐term intubation on premature infants and critically ill neonates, allowing for increased survival rates.…”

Section: Introductionmentioning

confidence: 99%

A standardized, closed‐loop system for monitoring pediatric tracheostomy‐related adverse events

et al. 2018

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Indications, Hospital Course, and Complexity of Patients Undergoing Tracheostomy at a Tertiary Care Pediatric Hospital

Cited by 60 publications

References 20 publications

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs*

A standardized, closed‐loop system for monitoring pediatric tracheostomy‐related adverse events

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