Yu H, et al. - The purpose of this trial was to evaluate the factors related to post-tracheotomy hospital readmission within 30 days of discharge. An unplanned hospital readmission occurred in over one-fifth of children undergoing tracheotomy, within 30 days after discharge. As a result of the majority of readmissions being unplanned and due to acute respiratory illnesses, prospective trials ought to determine how discharge procedures and improved care coordination could lower readmission rates in high-risk patients (e.g., patients discharged on positive pressure ventilation).

Methods

• Using the ICD-9 procedure codes, the authors selected children 18 years and younger, who underwent tracheotomy at Children's Hospital Los Angeles (CHLA) between 1/1/2005 and 12/31/2013, with at least 30 days of follow-up at CHLA.
• Patient characteristics and covariates were extracted by linking manual chart review and administrative data.
• The multivariate logistic regression was utilized in order to determine the independent correlation between risk factors and the primary outcome of 30-day all-cause same-hospital readmission.

Results

• Among the 273 patients, the median age at admission was 6 months [interquartile range (IQR): 1-51 months].
• The enrollees were primarily male (60.8%) and Hispanic (66.3%) cohort with a high proportion of discharge on positive pressure ventilation (47.1%), the 30-day readmission rate was 22% (n=60).
• Of the readmissions, 92% (n=55) were unplanned and 64% (n=35) were associated with acute respiratory illnesses.
• Multivariate regression analysis revealed a connection among patients ≤12 months, discharge on positive pressure ventilation [adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 1.19-6.97] with increased odds of readmission.
• On the other hand, gastrostomy tube placement during the tracheotomy hospitalization (aOR = 0.42, 95% CI = 0.19-0.96) and prematurity (aOR = 0.35, 95% CI = 0.15-0.83) correlated with decreased odds of readmission.
• Increased length of hospitalization (aOR = 1.01 per hospital day, 95% CI = 1-1.02) and presence of comorbid malignancy (aOR = 6.03, 95% CI = 1.25-29.16) displayed a link with increased odds of readmission, in patients >1 year of age.