Predictors of Pediatric Tracheostomy Outcomes in the United States
Predictors of Pediatric Tracheostomy Outcomes in the United States
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DOI：
10.1177/0194599820917620
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发表时间：
2020-04-21
影响因子：
3.4
通讯作者：
Brigger, Matthew T.
中科院分区：
文献类型：
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作者：
Friesen, Tzyynong L.;Zamora, Steven M.;Brigger, Matthew T.
目的探讨人口学和合并症对儿童气管切开术效果的影响。研究设计回顾国家数据库。设置全美52家儿童医院。研究对象和方法从儿童健康信息系统数据库中提取2010-2018年间18岁以下患者的住院记录和气管切开术的操作代码。主要结果是总住院时间。次要结果是30天再入院时间、死亡率和气管切开术后住院时间。住院总天数的中位数为77天，从2010年的59天增加到2018年的103天(P<；.001)。气管切开后住院时间的中位数为34天，也从27天增加到49天(P<；.001)。多因素回归分析显示，1岁以下儿童、黑人患者、非西部地区医院、出院患者和合并症患者的总住院时间和气管切开后住院时间显著增加。社会经济指标，如保险类型和估计家庭收入，与无差异或影响程度较小有关。地区和合并症与30天再入院时间的差异有关(总体26%)，而住院死亡率主要与年龄和合并症有关(总体8.6%)。结论儿童气管切开术需要大量的卫生保健资源，近年来住院时间不断上升。年龄、种族、地区、出院目的地和合并症与住院时间的差异有关。
ObjectivesTo investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities.Study DesignRetrospective national database review.SettingFifty-two children's hospitals across the United States.Subjects and MethodsHospitalization records from Pediatric Health Information System database dated 2010 to 2018 with patients younger than 18 years and procedure codes for tracheostomy were extracted. The primary outcome was total length of stay. The secondary outcomes were 30-day readmission, mortality, and posttracheostomy length of stay.ResultsA total of 14,155 children were included in the analysis. The median total length of stay was 77 days and increased from 59 to 103 days between 2010 and 2018 (P < .001). The median posttracheostomy length of stay was 34 days and also increased from 27 to 49 days (P < .001). On multivariate regression analyses, the total and posttracheostomy lengths of stay were significantly increased in children younger than 1 year, patients of black race, hospitals in the non-West regions, those discharged to home, and those with comorbidities. Socioeconomic indicators such as insurance type and estimated household income were associated with no difference or small effect sizes. Regions and comorbidities were associated with differences in 30-day readmission (overall 26%), while in-hospital mortality was primarily associated with age and comorbidities (overall 8.6%).ConclusionPediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.