Abstract
BACKGROUND AND OBJECTIVES: Children with new tracheostomy and invasive mechanical ventilation (IMV) require transitional care involving caregiver education and nursing support. To better understand hospital resource use during this transition, our study aimed to: (1) define and characterize low-resource days (LRDs) for this population and (2) identify factors associated with LRD occurrence. METHODS: This retrospective cohort analysis included children #21 years with new tracheostomy and IMV dependence admitted to an ICU from 2017 to 2022 using the Pediatric Health Information System database. A LRD was defined as a post tracheostomy day that accrued nonroom charges <10% of each patient’s accrued nonroom charges on postoperative day 1. Factors associated with LRDs were analyzed using negative binomial regression. RESULTS: Among 4048 children, median post tracheostomy stay was 69 days (interquartile range 34–127.5). LRDs were common: 38.6% and 16.4% experienced $1 and $7 LRDs, respectively. Younger age at tracheostomy (0–7 days rate ratio [RR] 2.42 [1.67–3.51]; 8–28 days RR 1.8 (1.2–2.69) versus 29–365 days; Asian race (RR 1.5 [1.04–2.16]); early tracheostomy (0–7 days RR 1.56 [1.2–2.04]), and longer post tracheostomy hospitalizations (31–60 days RR 1.85 [1.44–2.36]; 61–90 days RR 2.14 [1.58–2.91]; >90 days RR 2.21 [1.71–2.86]) were associated with more LRDs. CONCLUSIONS: Approximately 1 in 6 children experienced $7 LRDs. Younger age, early tracheostomy, Asian race, and longer hospital stays were associated with increased risk of LRDs. Understanding the postacute phase, including bed utilization, serves as an archetype to explore care models for children with IMV dependence.
| Original language | English (US) |
|---|---|
| Article number | e2023064920 |
| Journal | Pediatrics |
| Volume | 154 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2024 |
Funding
*The development of the RACHS-2 code used in this publication was supported by the National Heart Lung and Blood Institute of the National Institutes of Health, under award number R01 HL150044 (PI: Anderson) and supported by the New York Congenital Heart Surgery-Collaborative for Longitudinal Outcomes and Utilization of Resources. (CHS-COLOUR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or of New York Congenital Heart Surgery-Collaborative for Longitudinal Outcomes and Utilization of Resources.32 We thank Sarah Sobotka, MD, MSCP for her contribution of survey data from her previously published work \u201CPediatric patients with home mechanical ventilation: The health services landscape.\u201D21
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health