Rates of 30-Day Emergency Department Visits and Readmissions in Adults After Tracheostomy

To quantify 30-day emergency department (ED) visits and hospital readmissions post-tracheostomy-distinguishing between tracheostomy and non-tracheostomy-related causes-and to identify revisit risk factors.

Retrospective cohort study of adult patients undergoing all-cause tracheostomy within the system between April 1, 2018, and April 1, 2025. Electronic Medical Record review captured demographic variables, outcomes, and mortality. Fisher's exact test and Fine and Gray's subdistribution hazard modeling assessed associations with in-hospital death and risk of revisit.

Among 618 patients, 119/618 (19.3%) died prior to discharge. Of the 499 patients discharged alive, 23 (4.6%) died within 30 days, for a cumulative 30-day mortality of 142/618 (23.0%). Among those alive at discharge, 57 patients (11.4%) accounted for 68 ED visits and 95 (19.0%) for 101 readmissions. ED-presenting patients were more likely to be admitted than discharged (36/57, 63.2%) and accounted for 36/95 (37.9%) of all readmissions-indicating most readmissions occurred as direct admissions from outside the ED. Most revisits were due to non-tracheostomy-related complications. Cardiovascular disease was a significant predictor of in-hospital mortality, while gastrostomy dependence was protective (p = 0.012, p < 0.001). Emergent tracheostomy, revision-tracheostomy, and discharge home increased ED utilization (p < 0.001, p = 0.042, p = 0.017). Gastrostomy dependence and presence of a ventriculoperitoneal shunt predicted readmission (p = 0.005, p < 0.001). Non-English primary language increased ED revisits, while Hispanic/Latino ethnicity was protective against readmission (p = 0.051, p = 0.049). Longer initial hospitalization decreased likelihood of both ED visits and readmissions (p = 0.017, p = 0.025).

Identification of risk factors for postdischarge hospital utilization can inform trajectory, allowing for realistic discharge planning, improving outcomes while reducing healthcare costs.

3b.