National Cohort Study of Health Care Resource Use After Pediatric Tracheostomy

Powell, Jason; Keltie, Kim; Sims, Andrew; Richardson, Hayley; Brodlie, Malcolm; Powell, Steven

doi:10.1001/jamapediatrics.2022.1069

Cited by 8 publications

(18 citation statements)

References 7 publications

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“…Technology dependence at discharge is an important patient-oriented outcome and is associated with increased risk of hospital readmission, healthcare resource utilization and financial burden. [22][23][24]…”

Section: Discussionmentioning

confidence: 99%

Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit

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Edwards

Flannery

et al. 2022

Pediatric Infectious Disease Journal

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Background: Serratia spp. are opportunistic, multidrug resistant, Gram-negative pathogens, previously described among preterm infants in case reports or outbreaks of infection. We describe Serratia late-onset infection (LOI) in very preterm infants in a large, contemporary, nationally representative cohort. Methods: In this secondary analysis of prospectively collected data of preterm infants born 401–1500 grams and/or 22–29 weeks gestational age from 2018 to 2020 at 774 Vermont Oxford Network members, LOI was defined as culture-confirmed blood and/or cerebrospinal fluid infection > 3 days after birth. The primary outcome was incidence of Serratia LOI. Secondary outcomes compared rates of survival and discharge morbidities between infants with Serratia and non-Serratia LOI. Results: Among 119,565 infants, LOI occurred in 10,687 (8.9%). Serratia was isolated in 279 cases (2.6% of all LOI; 2.3 Serratia infections per 1000 infants). Of 774 hospitals, 161 (21%) reported at least one Serratia LOI; 170 of 271 (63%) cases occurred at hospitals reporting 1 or 2 Serratia infections, and 53 of 271 (20%) occurred at hospitals reporting ≥5 Serratia infections. Serratia LOI was associated with a lower rate of survival to discharge compared with those with non-Serratia LOI (adjusted relative risk 0.88, 95% CI: 0.82–0.95). Among survivors, infants with Serratia LOI had higher rates of tracheostomy, gastrostomy and home oxygen use compared with those with non-Serratia LOI. Conclusions: The incidence of Serratia LOI was 2.3 infections per 1000 very preterm infants in this cohort. Lower survival and significant morbidity among Serratia LOI survivors highlight the need for recognition and targeted prevention strategies for this opportunistic nosocomial infection.

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Section: Discussionmentioning

confidence: 99%

Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit

Coggins

Edwards

Flannery

et al. 2022

Pediatric Infectious Disease Journal

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“…Tracheostomy has multiple benefits over other methods of intubation and ventilation. However, in children it is frequently associated with ongoing respiratory complications, accounting for up to half of all hospital readmissions (2)(3)(4)(5). Frequent hospitalisation is associated with significant healthcare costs, and a negative impact on quality of life for children and their carers (2)(3)(4)(5)(6)(7).…”

Section: Text Introductionmentioning

confidence: 99%

“…However, in children it is frequently associated with ongoing respiratory complications, accounting for up to half of all hospital readmissions (2)(3)(4)(5). Frequent hospitalisation is associated with significant healthcare costs, and a negative impact on quality of life for children and their carers (2)(3)(4)(5)(6)(7). Mortality rates in tracheostomised children are in the region of 10-30% with later respiratory complications the predominant causes of death (2)(3)(4)(5)(6)(7)(8)(9).…”

Section: Text Introductionmentioning

confidence: 99%

“…Frequent hospitalisation is associated with significant healthcare costs, and a negative impact on quality of life for children and their carers (2)(3)(4)(5)(6)(7). Mortality rates in tracheostomised children are in the region of 10-30% with later respiratory complications the predominant causes of death (2)(3)(4)(5)(6)(7)(8)(9). Pediatric tracheostomy is commonly associated with antibiotic-resistant pathogens (10,11).…”

Section: Text Introductionmentioning

confidence: 99%

“…Tracheostomy in children is performed to facilitate long-term ventilation, assist weaning, or overcome airway obstruction (1). Most pediatric tracheostomies are performed in infancy, with children remaining cannulated for many years, and often life-long (1, 2). Tracheostomy has multiple benefits over other methods of intubation and ventilation.…”

Section: Introductionmentioning

confidence: 99%

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Tracheostomy in children promotes persistent neutrophilic airway inflammation

Powell

Mather

et al. 2022

Preprint

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Background: Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs, and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses. Methods: Tracheal aspirates, tracheal cytology brushings, nasal swabs and stool samples were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic, and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome. Results: Children followed up serially from the time of tracheostomy up to three months post-procedure (n=9) were studied. A validation cohort of children with a long-term tracheostomy was also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Tracheostomy was associated with new, rapidly emergent and sustained airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. In contrast, reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter. Conclusions: Childhood tracheostomy is associated with rapidly emergent and persistent airway neutrophil recruitment and activation, with sustained proteolysis and superoxide generation. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.

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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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National Cohort Study of Health Care Resource Use After Pediatric Tracheostomy

Cited by 8 publications

References 7 publications

Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit

Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit

Tracheostomy in children promotes persistent neutrophilic airway inflammation

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

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