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Hospital readmission and mortality after discharge with pediatric tracheostomy: A one-year population-based cohort
Chia-Hsuan Lee1, Che-Yi Lin2, Kun-Tai Kang3
1Department of Otolaryngology and Sleep Center, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Oral Hygiene, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan.
Insights
Pediatric tracheostomy patients face high readmission and mortality risks within one year. Younger children, particularly infants and toddlers, experience significantly greater risks following this procedure.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Health outcomes research
Background:
- Pediatric tracheostomy is a critical intervention for airway management in children.
- Understanding post-discharge outcomes is essential for optimizing patient care and resource allocation.
Purpose of the Study:
- To analyze hospital readmission and mortality rates within one year after pediatric tracheostomy.
- To identify factors associated with readmission and mortality in this vulnerable population.
Main Methods:
- Retrospective analysis of Taiwan's National Health Insurance Research Database (2001-2019).
- Inclusion of inpatients under 18 years who underwent tracheostomy.
- Calculation of all-cause readmission and mortality rates at multiple time points (30-365 days) and multivariable analysis of associated factors.
Main Results:
- 1911 children underwent tracheostomy; 78% experienced readmission and 14% died within one year.
- Accumulated 1-year readmission rate was 78%, with mortality at 14%.
- Younger age (infants, toddlers) was a significant risk factor for both readmission and mortality, along with longer ICU and hospital stays.
Conclusions:
- Young children, especially infants and toddlers, are at a substantially higher risk of readmission and mortality after tracheostomy.
- Early identification and targeted interventions for high-risk pediatric patients are crucial for improving outcomes.
Objective:
To analyze hospital readmission and mortality rates within 1 year after discharge with pediatric tracheostomy.
Methods:
Data were obtained from Taiwan's National Health Insurance Research Database. All inpatients aged <18 years who underwent tracheostomy between 2001 and 2019 were identified using International Classification of Diseases codes. All-cause readmission and mortality rates at 30, 90, 180, 270, and 365 days after pediatric tracheostomy were calculated, and factors associated with readmission and mortality at 1 year after tracheostomy were analyzed.
Results:
A total of 1911 children who underwent tracheostomy were included. At 1 year after tracheostomy, 1485 (78 %) children experienced hospital readmission, and 273 (14 %) died. The accumulated readmission rates at 30, 90, 180, 270, and 365 days were 32 %, 56 %, 69 %, 74 %, and 78 %, respectively. The accumulated mortality rates at 30, 90, 180, 270, and 365 days were 2 %, 6 %, 9 %, 12 %, and 14 %, respectively. Children who experienced readmission within the 1-year follow-up period were significantly younger (8.3 vs 9.9 years) and less indicated for trauma or head injury (33 % vs 39 %), and they had longer intensive care unit stays (38 days vs 30 days) and hospital stays (62 days vs 51 days) than had those without readmission. Multivariable analysis revealed that infants (HR = 1.20, 95 % CI: 1.01 to 1.44) and toddlers (HR = 1.24, 95 % CI: 1.04 to 1.48) were at significantly greater risk of readmission than were adolescents during the 1-year follow-up period. Mortality risk within this period was significantly higher among infants, toddlers, preschoolers, and school-aged children than among adolescents.
Conclusion:
Children at young ages are at greater risk of readmission and mortality following tracheostomy.
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