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

Abstract

AbstractObjectiveDetermine whether rurality or public insurance status is associated with greater 30‐day readmission after tracheostomy in pediatric patients.Study DesignRetrospective cohort.SettingPediatric Health Information System (PHIS) Database.MethodsPatients within PHIS who underwent tracheostomy from 2013 to 2017 were included. Rural status was defined by rural‐urban commuting area codes. Insurance status was based on the primary payer. All‐cause 30‐day readmissions and tracheostomy‐related readmissions were recorded. Multivariate logistic regression was performed to test for differences in readmissions between cohorts.ResultsAmong patients, 1092 were rural, and 4329 were publicly insured, with no significant association between rurality and insurance. Compared to nonrural patients, rural patients were more frequently white, less frequently ventilator dependent, and more likely discharged home rather than to a care facility. Publicly insured patients were more frequently non‐white. Twenty‐eight percent of patients were readmitted within 30 days of discharge. Odds of 30‐day readmission were lower in rural patients (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.68‐0.95, p = .01) but higher in publicly insured (OR: 1.24, 95% CI: 1.09‐1.42, p = .001) controlling for age at tracheostomy, sex, race, and ventilator dependence. The odds of tracheostomy‐related admission did not differ by rurality but were higher in publicly insured children (1.39, 95% CI: 1.03‐1.88, p = .03).ConclusionReadmission within 30 days following tracheostomy was more likely in publicly insured patients and less likely in rural patients. These findings help identify at‐risk patients when considering discharge planning and follow‐up. More work is needed to understand long‐term tracheostomy outcomes in these groups.