Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study

• Published in: BMJ paediatrics open 2024-03, Vol.8 (1), p.e002377
• Main Authors: Song, In Gyu, Kim, You Sun, Kim, Min Sun, Lee, Ji Weon, Cho, Yoon-Min, Lim, Youna, Kwon, Seong Keun, Suh, Dong In, Park, June Dong
• Format: Article
• Language: English
• Subjects: Age; Airway management; Child; Child, Preschool; Chronic Disease; Chronic illnesses; Codes; Delivery of Health Care; Demographics; Emergency medical care; ENT; Families & family life; Health Services; Health services research; Health services utilization; Hospitalization; Humans; Infant; Medical aid; Mortality; National health insurance; Neonatology; Nursing; Ostomy; Patients; Pediatrics; Retrospective Studies; Tracheostomy; Tracheotomy; Trends
• ISSN: 2399-9772; 2399-9772
• DOI: 10.1136/bmjpo-2023-002377

BackgroundDespite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years.MethodsThis retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality.ResultsIn total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk.ConclusionPaediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.