Published online July 13, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 563-572 (doi:10.1542/peds.2008-3491)

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ARTICLE

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

Jay G. Berry, MD, MPH^a,b, Dionne A. Graham, PhD^b,c, Robert J. Graham, MD^d, Jing Zhou, MS^c, Heather L. Putney, MS^e, Jane E. O'Brien, MD^a,f, David W. Roberson, MD^b,g and Don A. Goldmann, MD^h

^a Complex Care Service
^c Clinical Research Program
^d Critical Care Medicine
^g Department of Otolaryngology
^h Division of Infectious Diseases and Pediatric Health Services Research
^b Program for Patient Safety and Quality, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
^e Institute for Community Inclusion
^f Franciscan Hospital for Children, Boston, Massachusetts

OBJECTIVES: The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use.

PATIENTS AND METHODS: A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children's hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations.

RESULTS: Forty-eight percent of children were 6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P .01), less decannulation (5.0% vs 11.0%; P .01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P .01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors.

CONCLUSIONS: Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.

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Key Words: tracheotomy • children • mortality • hospitalization • health services • outcomes

Abbreviations: MV—mechanical ventilation • NI—neurologic impairment • PHIS–Pediatric Health Information System • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • CP—cerebral palsy • BiPAP—bilevel positive airway pressure • CPAP—continuous positive airway pressure • MCD—major diagnostic category

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Accepted Feb 20, 2009.

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