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.

Conclusions : This 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.