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Tracheotomy in pediatric patients: a national perspective
Charlotte W Lewis1, Jeffrey D Carron, Jonathan A Perkins
1Child Health Institute, University of Washington, Seattle 98195-4920, USA. cwlewis@u.washington.edu
Insights
Pediatric tracheotomy rates and outcomes vary significantly across the US. Children
Area of Science:
- Pediatric surgery
- Healthcare outcomes research
- Epidemiology of medical procedures
Background:
- Tracheotomy indications and implications in children have evolved due to changes in infectious disease epidemiology and medical technology over 50 years.
- The complexity of care for pediatric tracheotomy patients necessitates monitoring procedure performance and outcomes across the US healthcare system.
Purpose of the Study:
- To characterize the population of children who underwent tracheotomy in 1997.
- To determine if patient disposition and mortality rates differ based on geographic region or healthcare system characteristics.
Main Methods:
- Retrospective cohort study using a nationally representative sample of 80% of hospital discharge records from pediatric admissions in 22 states in 1997.
- Analysis included patients aged 0 to 18 years who underwent tracheotomy.
- Weighted descriptive statistics and Poisson regression analyses were performed to estimate national and regional rates and analyze outcome variations.
Main Results:
- An estimated 4861 tracheotomies were performed in 1997, with the highest rates among infants.
- Tracheotomy rates varied significantly by US region. Children's hospitals and teaching hospitals showed lower mortality and discharge to long-term care rates, respectively.
- Hospitals with higher pediatric tracheotomy case volumes had lower mortality rates. Northeast patients were twice as likely to be discharged to long-term care compared to Western patients.
Conclusions:
- Significant variations in pediatric tracheotomy rates and patient outcomes exist across different US regions and hospital types.
- Further research is needed to understand the underlying reasons for these observed associations in pediatric tracheotomy care.
Background:
During the past 50 years, changes in the epidemiology of infectious diseases and the capabilities of medical technology have altered the indications for, and implications of, tracheotomy in children. Given the complexity of health care that these patients subsequently require, monitoring the performance of this procedure and patient outcomes across the diverse US health care system is warranted.
Objectives:
To characterize children who received tracheotomies in 1997 and to determine whether disposition and mortality vary by region or health care system attributes.
Design:
A nationally representative retrospective cohort drawn from an 80% sample of administrative hospital discharge records from all pediatric admissions in 22 states during 1997.
Participants:
Patients aged 0 to 18 years who underwent tracheotomy.
Methods:
The sampling scheme of the discharge records enabled the calculation of regional and national estimates and of age-stratified population-based rates of tracheotomies. Weighted descriptive statistical and Poisson analyses were performed.
Results:
The 2065 tracheotomy procedures recorded in the Kids' Inpatient Database yielded a national estimate of 4861 tracheotomies performed in 1997. The mean length of hospital stay was 50 days, with a mean total facilities charge exceeding $200,000. The rate of tracheotomy was highest among infants and varied significantly across regions of the United States. Adjusting for other patient and health care system attributes, patients who received their tracheotomy in a children's hospital had half the risk of dying during the admission compared with patients who were cared for in a non-children's hospital. Hospitals that performed more pediatric tracheotomies had significantly lower mortality rates than hospitals with lesser case volume. Among patients who survived to discharge, those cared for in the Northeast were discharged to long-term care facilities at twice the rate of patients in the West. Children cared for in children's hospitals or in teaching hospitals were significantly less likely to be discharged to a long-term care facility.
Conclusions:
Pediatric tracheotomy is associated with significant variation in rates and outcomes across the United States and across different hospital types. Further research to clarify the reasons for these associations is warranted.
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