Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy

Area of Science:

• Pediatric critical care medicine
• Respiratory therapy
• Healthcare economics

Background:

• Increasing numbers of children are discharged from pediatric ICUs requiring prolonged mechanical ventilation (PMV) via tracheostomy.
• These patients experience extended hospitalizations and significant resource utilization.
• Understanding the characteristics and costs of this patient population is crucial for resource allocation and care planning.

Purpose of the Study:

• To describe the characteristics of pediatric patients discharged on PMV via tracheostomy.
• To evaluate the associated costs of care for these patients.
• To compare resource utilization and outcomes between patients with neurologic versus respiratory diagnoses.

Main Methods:

• A retrospective review of 50 pediatric subjects who underwent new tracheostomy placement and were enrolled in a home mechanical ventilation program between January 2015 and December 2017.
• Data collected included demographics, tracheostomy indication, length of stay (LOS), hospital costs, readmissions, and outcomes.
• Comparative analysis was performed between subjects with respiratory and neurologic diagnoses.

Main Results:

• The average initial hospitalization cost was $622,671 per subject, with an average LOS of 155 days.
• Patients with respiratory diagnoses had longer LOS and higher average costs compared to those with neurologic diagnoses.
• The average readmission rate was 2.16 per subject in the first year, with an average readmission cost of $73,144 per subject.

Conclusions:

• Pediatric patients discharged on PMV via tracheostomy represent a high-cost, resource-intensive group.
• Contrary to the hypothesis, patients with neurologic diagnoses had shorter LOS and lower hospital costs than those with respiratory diagnoses.
• No significant differences in outcomes were observed between the diagnostic groups.