Risk factors associated with unplanned readmissions and frequent emergency department visits after pediatric tracheostomy: a nation-wide inpatient database study in Japan

Purpose Children who undergo tracheostomy sometimes experience unexpected readmissions and frequent emergency department (ED) visits. Revealing the risk factors of medical resource use may help improve health outcomes. This study aimed to describe the clinical features of children who underwent tracheostomy and to determine the risk factors associated with unplanned readmission and frequent out-of-hour ED visits. Methods 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 estimated using multiple logistic regression analysis. Results A total of 1112 patients underwent tracheostomy during the study period. A total of 483 (43%) patients were readmitted and 220 (20%) visited the ED frequently. The multiple logistic regression analysis showed that less than 1 years-of-age (Odds ratio [OR]:1.77; 95% confidence interval [CI]:1.26–2.47; p < .05), tube feeding (OR:1.36; 95% CI:1.03–1.80; p < .05), neuro-impairment (OR:1.52; 95% CI:1.02–2.25; p < 05), and mechanical ventilation (OR:1.94; 95% CI:1.29–2.92; p < .05) were risk factors for readmissions. Moreover, less than 1 years-of-age (OR:1.53; 95% CI:1.03–2.27; p < .05), home oxygen therapy (OR:1.94; 95% CI: 1.29–2.92; p < .05), and unplanned tracheostomy (OR:2.38; 95% CI: 1.05–5.40; p < .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. This study may help improve health outcomes, healthcare plans, and evidence-based policymaking.