Low-Resource Hospital Days for Children Following New Tracheostomy

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.