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Risk of death at home or on hospital readmission after discharge with pediatric tracheostomy

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Abstract

Objective

To evaluate outcomes of patients discharged home following tracheostomy, including the timing and place of death for non-survivors.

Study design

We retrospectively reviewed medical records of infants undergoing tracheostomy between 2006 and 2017, within the first year of life for congenital or acquired neonatal conditions.

Results

Of the 224 patients discharged after tracheostomy, 127 (57%) required home mechanical ventilation (MV). Overall, 40 (18%) patients died (65% were on MV); 38% of the deaths occurred at home and 63% at a subsequent hospitalization. Having tube feeding was identified as significantly associated with increased mortality on multivariate analysis. Having a tracheostomy for upper airway obstruction was the only variable significantly associated with increased risk of death at home on multivariate analysis.

Conclusions

Having tube feeding was associated with increased risk of death overall and having the tracheostomy for obstructive airway conditions was associated with death occurring at home.

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Fig. 1: Consort diagram of patients selected for analysis.
Fig. 2: Duration of time, in days, from discharge to death for the groups that died at home or during a subsequent hospitalization.
Fig. 3: Cumulative survival after discharge to home for the groups that died at home or died during a subsequent hospitalization.

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Data availability

The de-identified data that support the findings of this study are available on request from the corresponding author. These data are not publicly available to respect the privacy of the patients.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Stephanie K. Kukora, Rachel A. Pace, Robert E. Schumacher & Mohammad A. Attar

  2. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109, USA

    Stephanie K. Kukora

  3. Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA

    Adam Van Horn & Aaron Thatcher

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Contributions

SSK assisted with the design project, assisted with data analysis, wrote the initial draft, and revised the manuscript. AVH assisted with data analysis, provided content expertise, and revised and provided critical feedback on the manuscript. AT assisted with data analysis, provided content expertise, and revised and provided critical feedback on the manuscript. RAP collected and de-identified the patient data. RES assisted with data analysis, provided content expertise, and revised and provided critical feedback on the manuscript. MAA devised the project, collected and de-identified the patient data, conducted data analysis, contributed to the initial draft, and revised the manuscript. We acknowledge Harlan McCaffery, MS, from Biostatistics and Data Management Unit at the University of Michigan for his Statistical support.

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Correspondence to Stephanie K. Kukora.

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Kukora, S.K., Van Horn, A., Thatcher, A. et al. Risk of death at home or on hospital readmission after discharge with pediatric tracheostomy. J Perinatol 43, 1020–1028 (2023). https://doi.org/10.1038/s41372-023-01721-5

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