National Cohort Study of Health Care Resource Use after Pediatric Tracheostomy

Pediatric tracheostomy becomes frequently necessary for enabling long-term ventilation. 

A new article published in JAMA Pediatrics aimed to report hospital health care resource use (HRU) and costs associated with caring for children after a tracheostomy, at national level.

The present study utilized a comprehensive database – the Hospital Episode Statistics (HES), including all National Health Service (NHS) admissions and daycare procedures conducted in hospitals across England.

Overall, 1,709 episodes of care were identified, which included 1,607 tracheostomies. After exclusions, 1,389 tracheostomy cases were identified.

The median length of stay was 39 nights. The number of in-hospital complications during tracheostomy were 634 – in 393 patients. Among these, 64%, 25%, 8%, and 3% had experienced 1, 2, 3, and 4 complications, respectively. 

The most common complication, tracheostomy malfunction accounted for 18% of all tracheostomy-related complications. Among 100 fatalities during tracheostomy admissions, the total recorded follow-up of 2,201,889 days was accrued. Readmissions among 1,186 patients were 17,032 – during the follow-up period. 

Subsequent readmissions accorded for – acute upper respiratory tract infection (RTI) for 972 admissions in 445 patients; acute lower RTI for 2,683 admissions in 688 patients; tracheostomy malfunction for 889 readmissions in 443 patients. Withing 30 days of discharge, 826 patients encountered 1,378 hospital readmissions.

Costs attributed to admissions for lower RTI was £8,446,138 in the first year and £3,203,246 in the second year. However, 145 patients perished during the follow-up, of which 34 deaths occurred within 30 days of discharge after tracheostomy. The mean 1-year survival was 86%; the value was 84.3% at 2 years.

Source: JAMA Pediatrics. 2022 May 16. doi: 10.1001/jamapediatrics.2022.1069.