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Published on: January 17, 2011
Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy
Colin M Rogerson1, Andrew L Beardsley2, Mara E Nitu2
1Riley Hospital for Children, Indianapolis, Indiana. crogerso@iupui.edu.
Insights
Children on prolonged mechanical ventilation (PMV) via tracheostomy incur high costs. Neurologic diagnoses associated with PMV had lower costs and shorter hospital stays than respiratory diagnoses.
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.
Background:
More children are discharged from ICUs on prolonged mechanical ventilation (PMV) via tracheostomy than ever before. These patients have long hospitalizations with high resource expenditure. Our objective was to describe the characteristics of these resource-intensive patients and to evaluate their costs of care. We hypothesized that subjects requiring PMV for neurologic diagnoses would have higher costs, longer hospital length of stay (LOS), and worse outcomes than those with primarily respiratory diagnoses.
Methods:
We identified 50 pediatric subjects between January 2015 and December 2017 at our institution who had a new tracheostomy placement and were enrolled in a home mechanical ventilation program. Collected data included demographics, indication for tracheostomy, LOS, hospital costs, readmissions, and outcomes. We also compared subjects who required PMV for respiratory diagnoses versus neurologic diagnoses.
Results:
Of 50 subjects, 41 were < 12 months old at the time of tracheostomy. Thirty-four subjects had a respiratory diagnosis requiring PMV, 14 had a neurologic diagnosis, and 2 had a cardiac diagnosis. The total initial hospitalization cost was $31,133,582, which averages to $622,671 per subject. The average initial hospitalization LOS was 155 d. Respiratory subjects had longer LOS and higher average costs than neurologic subjects. The average readmission rate was 2.16 per subject in the first year after discharge, and the average readmission cost per subject was $73,144. Eight subjects died in the first year after discharge, and 4 suffered a serious morbidity.
Conclusions:
This descriptive study evaluated the social and medical characteristics of subjects being discharged from the pediatric ICU with PMV via tracheostomy, as well as quantified the financial impact of their care. Those requiring PMV for neurologic diagnoses had shorter hospital LOS and lower hospital costs than those with respiratory diagnoses. No definitive differences in outcomes were found.
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