Outpatient healthcare use and outcomes after pediatric tracheostomy

To 1) describe health outcomes and outpatient healthcare use after pediatric tracheostomy, and 2) identify populations with higher morbidity that may benefit from improved post-operative monitoring.

Optum's commercial insurance database was queried from 2003 to 2019. Children aged 0-18 who received tracheostomy identified. Mortality, decannulation, tracheostomy complications, and home ventilator dependence were determined, as well as physician office visits and specialty type. The effect that patient characteristics (age, sex, ethnicity, prematurity, and presence versus absence of chronic lung disease [CLD], congenital heart disease [CHD], neurologic impairment [NI], and upper airway obstruction [UAO]) had on outcomes were compared.

1231 children were identified. Infants accounted for 33% of patients and 40% of the cohort was premature. The most common comorbid conditions were NI (76%), UAO (69%), CLD (48%), and CHD (35%). Within 5 years postoperatively, 25% died, 45% had home ventilator dependence, 53% had a complication, and 10% were decannulated. CHD was associated with higher risk of death (HR,1.98; 95% CI 1.22, 3.21), while UAO was associated with lower risk of death (HR,0.51; 95% CI 0.32, 0.83) and higher probability of decannulation (HR,3.56, 95% CI 1.08, 11.74). The median number of physician office visits was 6 per year (IQR 3,10). The most common specialty types were pediatrics (32%), pulmonary medicine (10%), and otolaryngology (8%). NI was associated with greater number of office visits (mean difference/year, 4.10; 95% CI 2.00, 6.19) while Hispanic ethnicity was associated with fewer visits (mean difference/year, -2.94; 95%CI -5.42, -0.45).

UAO was associated with lower risk of mortality and higher probability of decannulation, while NI was associated with greater outpatient healthcare utilization. Social disparities in outpatient tracheostomy care were observed.