Predictors of Pediatric Tracheostomy Outcomes in the United States

Friesen, Tzyynong L.; Zamora, Steven; Rahmanian, Ronak; Bundogji, Nour; Brigger, Matthew T.

doi:10.1177/0194599820917620

Cited by 40 publications

(64 citation statements)

References 22 publications

(65 reference statements)

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“…These values are longer than the median LOS reported in previous studies of US pediatric tracheostomy patients. 1,9,17,18 However, LOS in the noncomplex group was consistent with lower ranges in prior published data. 9,18 Hospital admission in this population is affected by complexity, which is notable as national data between 2010 and 2018 increasingly shows that pediatric tracheostomies are performed in more complex children.…”

Section: Discussionsupporting

confidence: 89%

“…1,9,17,18 However, LOS in the noncomplex group was consistent with lower ranges in prior published data. 9,18 Hospital admission in this population is affected by complexity, which is notable as national data between 2010 and 2018 increasingly shows that pediatric tracheostomies are performed in more complex children. 9 The results from this study includes only recent data from a tertiary academic center that may have a higher concentration of complex patients.…”

Section: Discussionsupporting

confidence: 89%

“…9,18 Hospital admission in this population is affected by complexity, which is notable as national data between 2010 and 2018 increasingly shows that pediatric tracheostomies are performed in more complex children. 9 The results from this study includes only recent data from a tertiary academic center that may have a higher concentration of complex patients. Further studies aimed at stratifying tracheostomy patients by complexity may confirm these results when compared with similar academic center cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports suggest that rates can be higher than the 18% identified in this series. 7,9,19 National data from the PHIS found a 26% 30-day readmission rate among pediatric tracheostomy patients and several studies of similar pediatric patient populations at single, large academic centers report 30-day all-cause readmissions greater than 20%. 7,9,17 The reasons are likely multi-faceted.…”

Section: Discussionmentioning

confidence: 99%

“…6 Unfortunately, existing literature is limited by retrospective data with short follow-up periods, which emphasizes the need for more procedurespecific data on pediatric tracheostomy. [6][7][8][9] The medical complexity of pediatric patients requiring tracheostomy has increased. 1,8,10 The medicallycomplex child has unique challenges that necessitate more specific data to improve care for this growing group of patients.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

et al. 2021

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Objectives/Hypothesis: To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.Study Design: Retrospective case series.Methods: All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.Results: A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.Conclusions: Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

et al. 2021

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The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

et al. 2021

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Objectives: To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy. Methods: We performed a retrospective case series of children who underwent tracheostomy. Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in-hospital mortality, and 30-day all-cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.Results: A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48-0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.Conclusions: Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.

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Racial Influences on Pediatric Tracheostomy Outcomes

et al. 2021

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Objectives/Hypothesis To determine the impact of race on outcomes after pediatric tracheostomy. Study Design Retrospective case series. Methods A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. Results A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P = .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P = .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P = .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P < .001), less extreme prematurity (44%, P < .001), and less BPD (21%, P = .04). The proportion of Black children was higher (30% vs. 19%, P < .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P = .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P = .51), decannulation (P = .17), or death (P = .92) after controlling for age, sex, prematurity, and ventilator dependence. Conclusion Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long‐term outcomes after pediatric tracheostomy. Laryngoscope, 132:1118–1124, 2022

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Predictors of Pediatric Tracheostomy Outcomes in the United States

Cited by 40 publications

References 22 publications

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

Racial Influences on Pediatric Tracheostomy Outcomes

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