Hospital Admissions in Pediatric Patients With Tracheostomies Based on Rurality and Insurance Status

Area of Science:

• Pediatric Surgery
• Health Services Research
• Healthcare Disparities

Background:

• Pediatric tracheostomy is a critical intervention for airway management.
• Understanding factors influencing readmission is crucial for optimizing patient outcomes.
• Rurality and public insurance status are potential social determinants of health impacting pediatric care.

Purpose of the Study:

• To investigate the association between rurality and public insurance status with 30-day readmission rates in pediatric patients following tracheostomy.
• To identify patient subgroups at higher risk for readmission after tracheostomy.

Main Methods:

• Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) Database (2013-2017).
• Defined rural status using rural-urban commuting area codes and insurance status by primary payer.
• Analyzed all-cause and tracheostomy-related 30-day readmissions using multivariate logistic regression.

Main Results:

• Rural patients showed lower odds of 30-day readmission (OR: 0.80, CI: 0.68-0.95).
• Publicly insured patients had higher odds of 30-day readmission (OR: 1.24, CI: 1.09-1.42) and tracheostomy-related readmission (OR: 1.39, CI: 1.03-1.88).
• No significant association was found between rurality and insurance status.

Conclusions:

• Publicly insured pediatric patients are at increased risk for 30-day readmission post-tracheostomy.
• Rural pediatric patients demonstrated a lower likelihood of 30-day readmission.
• Findings highlight the need for targeted discharge planning and follow-up for vulnerable pediatric populations.