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Beyond survival: Readmissions and late mortality in pediatric ECMO survivors
Amy E Lawrence1, Yuri V Sebastião1, Katherine J Deans1
1Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) survivors face high readmission rates. Approximately 35.6% experienced unplanned readmissions, with a 3% mortality risk during these events within one year post-discharge.
Area of Science:
- Pediatric critical care medicine
- Extracorporeal membrane oxygenation (ECMO) outcomes
- Health services research
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for critically ill pediatric patients.
- Understanding post-discharge outcomes, including readmission and mortality, is crucial for improving long-term care.
- Previous studies have not fully elucidated readmission rates and associated mortality in pediatric ECMO survivors.
Purpose of the Study:
- To determine the rates of hospital readmission and late mortality among pediatric patients following discharge after ECMO treatment.
- To identify key factors predicting readmission and late mortality in this vulnerable patient population.
- To analyze the impact of initial hospital course characteristics and ECMO center volume on patient outcomes.
Main Methods:
- A population-based retrospective cohort study was conducted using State Inpatient Databases from 10 states.
- Included were pediatric patients discharged after ECMO, with time-to-event analyses employed.
- Factors analyzed included ECMO indication, chronic conditions, transfer status, discharge destination, and health insurance.
Main Results:
- Of 1603 identified pediatric ECMO patients, 42.4% died before discharge.
- Among 924 ECMO survivors, 35.6% had an unplanned readmission within one year.
- Readmission risk was linked to ECMO indication, chronic conditions, transfer status, and discharge destination; late mortality risk was associated with insurance, transfer status, chronic conditions, and ECMO indication.
Conclusions:
- Pediatric ECMO survivors exhibit a substantial risk of hospital readmission.
- Approximately 3% of these survivors experience mortality during readmissions within the first year post-discharge.
- Specific patient and hospital course factors significantly influence readmission and late mortality risks.
Introduction:
The objective of our study was to identify rates of readmission and late mortality in pediatric extracorporeal membrane oxygenation (ECMO) patients after discharge from their ECMO hospitalization.
Methods:
We conducted a population-based retrospective cohort study of children who were discharged after ECMO. Data were obtained from the State Inpatient Databases for 10 states. Time-to-event analyses were used to estimate the risk of readmission and to identify factors predictive of readmission and late mortality, including characteristics of initial hospital course and ECMO center volume.
Results:
A total of 1603 pediatric ECMO patients were identified, and 42.4% of these patients died prior to discharge. Of the 924 ECMO survivors, 35.6% had an unplanned readmission, and 3% died during readmission within 1 year. The risk of readmission was significantly related to the indication for ECMO, number of complex chronic conditions, transfer status, and discharge destination (all p<0.05). The risk of late mortality was significantly related to health insurance, transfer status, number of complex chronic conditions, and indication for ECMO (all p<0.05).
Conclusions:
Pediatric ECMO survivors have a high risk of hospital readmission with approximately 3% mortality during readmissions within 1 year of initial discharge.
Type Of Study:
Retrospective Cohort Study LEVEL OF EVIDENCE: Level III.
