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Pediatric Otolaryngology

(142) Discharge Location Following Pediatric Tracheostomy: A National Cohort Analysis

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Diya Ramanathan, BA

    Medical student
    Case Western Reserve University School of Medicine
    Cleveland, Ohio, United States

    • Author(s)

  • DB

    David Bruckman, MS

    Senior Biostatistician
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    • Senior Author(s)

  • Brandon S. Hopkins, MD

    Assistant Professor Pediatric Otolaryngology
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

Disclosure(s):
Diya Ramanathan, BA: No relevant relationships to disclose.
David Bruckman, MS: No relevant relationships to disclose.
Brandon S. Hopkins, MD: No relevant relationships to disclose.


Introduction: Discharge location following pediatric tracheostomy is pertinent as it may impact access to postoperative care. Our aim is to evaluate discharge locations among pediatric tracheostomy patients (PTP) and identify associated demographic variables.

Methods: We used HCUP Kids’ Inpatient Database for 2016 and 2019 for discharges aged 0-17 years. ICD-10-PCS codes for PTP and HCUP data variables of interest were selected. Discharge numbers were reweighted to derive average annual discharges, and total costs were calculated using the HCUP Cost-To-Charge ratios, then adjusted for inflation.

Results: Of 5,279,243 age-eligible records, 5,689 records were identified, reflecting an annual average of 3,895 discharges. 40.2% were sent home for self-care, 18.7% home with home health care, 22.2% skilled nursing facility, intermediate care facility, or other facility, and 11.2% short-term hospital.

43.6% of patients were White, 24.1% Black, 20.9% Hispanic, and 3.5% Asian/Pacific Islander. 24.8% were neonates, and 24.9% were < 1 year old. 56.1% came from large metropolitan areas, with 12.6% from rural areas. 97.2% of discharges were from urban teaching hospitals. 58.4% were on Medicaid and 35.3% on private insurance. Discharges came from the South (41.2%), Midwest (22.5%), West (20.1%), and Northeast (16.2%).

Inpatient mortality rates were 13.3% for neonates, 8.2% 1-11 months, 3.5% 1-5 years, 3.7% 6-10 years, and 5.0% 11-17 years old. The mean inflation-adjusted total cost of admission was $424,387 (95% CI 399955, 448819) and median was $243,479 [25th-75th quartile 101078, 562245]. Median length of stay was 1.7 days (25th-75th quartile 1.1, 2.8).

Conclusions: There are high rates of tracheostomy among neonates and infants < 12 months, as well as patients from large metropolitan areas, urban teaching hospitals, and the South, which has a proportionately higher patient volume. This data substantiates the high cost of PTP admissions, with relatively short lengths of stay. Examining trends is important in uncovering disparities in post-tracheostomy care and outcomes.