Pediatric Tracheostomy-Related Complications: A Cross-sectional Analysis.

Abstract

To determine the rate of tracheostomy-related complications in pediatric patients from nationally representative databases. Cross-sectional analysis. 2016 Kids' Inpatient Database and 2016 Nationwide Readmission Database. All pediatric tracheostomy procedures were included. Complication type, admission outcomes, and readmission rates were recorded with a logistic regression analysis to determine patient characteristics associated with complications. An estimated 5309 tracheostomies were performed among pediatric patients in 2016, 8% (n = 432) of whom developed tracheostomy-related complications. This group was younger (4.7 vs 8.7 years, <i>P</i> < .001) and required longer hospital admissions (68.7 vs 33.2 days, <i>P</i> < .001) than children without tracheostomy-related complications. Mean costs ($459,324 vs $397,937, <i>P</i> < .001) and mean total charges ($1,573,964 vs $1,099,347, <i>P</i> < .001) were increased if a tracheostomy-related complication occurred. These events occurred more often in those with bronchopulmonary dysplasia (24% vs 12%, <i>P</i> < .001), heart disease (24% vs 12%, <i>P</i> = .001), gastroesophageal reflux disease (31% vs 19%, <i>P</i> < .001), short gestational age (24% vs 14%, <i>P</i> < .001), and subglottic stenosis (9.9% vs 5.4%, <i>P</i> = .001). The estimated 30-day readmission rate was 24% (SE, 1.7%) but did not increase after tracheostomy complications (27% vs 15%, <i>P</i> = .04). Tracheostomy-related complications were predicted by gastroesophageal reflux disease (odds ratio [OR], 1.50; 95% CI, 1.14-1.97; <i>P</i> = .004), younger age (OR, 1.12; 95% CI, 1.04-1.22; <i>P</i> = .002), and lengthier hospitalization (OR, 1.00; 95% CI, 1.00-1.01; <i>P</i> < .001) on multiple logistic regression analysis. Tracheostomy-related complications occur in approximately 8% of pediatric patients and are higher in younger children or those with longer admission lengths. These data have implications for benchmarking standards of posttracheostomy complications across institutions.