Risk factors associated with unplanned readmissions and frequent out-of-hour emergency department visits after pediatric tracheostomy: a nationwide inpatient database study in Japan.

Children who undergo tracheostomy usually experience unexpected readmissions and frequent emergency department (ED) visits. Therefore, identifying the risk factors associated with medical resource use may help improve health outcomes. This study aimed to describe the clinical features of children who underwent tracheostomy and determine the risk factors for unplanned readmission and frequent out-of-hour ED visits. Data of children aged between 0 and 18 years who underwent tracheostomy and were discharged between April 2016 and March 2019 were retrieved from the Japanese National Inpatient Database and retrospectively analyzed. Risk factors for readmission and frequent out-of-hour ED visits within 180 days of tracheostomy were identified using multivariate logistic regression analysis. Overall, 1112 patients underwent tracheostomy during the study period; 483 (43%) patients were readmitted, and 220 (20%) visited the ED frequently. The multivariate logistic regression analysis showed that < 1 year of age (odds ratio (OR) = 1.77; 95% confidence interval (CI) 1.26-2.47; p < 0.05), tube feeding (OR = 1.36; 95% CI 1.03-1.80; p < 0.05), neurological impairment (OR = 1.52; 95% CI 1.02-2.25; p < 0.05), and mechanical ventilation (OR = 1.43; 95% CI 1.03-1.99; p < 0.05) were risk factors for readmissions. In contrast, < 1 year of age (OR = 1.53; 95% CI 1.03-2.27; p < 0.05), home oxygen therapy (OR = 1.94; 95% CI 1.29-2.92; p < 0.05), and unplanned tracheostomy (OR = 2.38; 95% CI 1.05-5.40; p < 0.05) were risk factors for ED visits.

conclusionsThis study describes the clinical features and risk factors for readmission and frequent out-of-hour ED visits after tracheostomy. The findings may contribute to improving health outcomes, healthcare plans, and evidence-based policymaking. WHAT IS KNOWN: • The use of tracheostomy in children with medical complexity has increased, and these children are known to be frequent users of medical resources. • Multicenter studies dealing with the long-term outcomes of pediatric tracheostomy and risk factors associated with high medical resource use are still limited. WHAT IS NEW: • Using the nationwide database in Japan, this study identified several risk factors associated with unplanned readmissions and out-of-hours emergency department visits (less than 1 years of ages, dependent on medical technologies, etc.). • This study contributes for coordinating appropriate home care plans and reducing preventable medical resource use.