Department of Surgery, Division of Otolaryngology, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA.
Division of Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA.
Otolaryngol Head Neck Surg. 2023 Jul;169(1):129-135. doi: 10.1002/ohn.250. Epub 2023 Jan 29.
Determine whether rurality or public insurance status is associated with greater 30-day readmission after tracheostomy in pediatric patients.
Retrospective cohort.
Pediatric Health Information System (PHIS) Database.
Patients within PHIS who underwent tracheostomy from 2013 to 2017 were included. Rural status was defined by rural-urban commuting area codes. Insurance status was based on the primary payer. All-cause 30-day readmissions and tracheostomy-related readmissions were recorded. Multivariate logistic regression was performed to test for differences in readmissions between cohorts.
Among patients, 1092 were rural, and 4329 were publicly insured, with no significant association between rurality and insurance. Compared to nonrural patients, rural patients were more frequently white, less frequently ventilator dependent, and more likely discharged home rather than to a care facility. Publicly insured patients were more frequently non-white. Twenty-eight percent of patients were readmitted within 30 days of discharge. Odds of 30-day readmission were lower in rural patients (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.68-0.95, p = .01) but higher in publicly insured (OR: 1.24, 95% CI: 1.09-1.42, p = .001) controlling for age at tracheostomy, sex, race, and ventilator dependence. The odds of tracheostomy-related admission did not differ by rurality but were higher in publicly insured children (1.39, 95% CI: 1.03-1.88, p = .03).
Readmission within 30 days following tracheostomy was more likely in publicly insured patients and less likely in rural patients. These findings help identify at-risk patients when considering discharge planning and follow-up. More work is needed to understand long-term tracheostomy outcomes in these groups.
确定农村地区或公共保险状况是否与儿科患者气管切开后 30 天内再入院率增加有关。
回顾性队列研究。
儿科健康信息系统（PHIS）数据库。
纳入 PHIS 数据库中 2013 年至 2017 年间接受气管切开术的患者。农村地区状态由城乡通勤区代码定义。保险状况基于主要支付方。记录所有原因 30 天再入院和气管切开术相关再入院。采用多变量逻辑回归检验队列之间再入院的差异。
在患者中，1092 例为农村地区，4329 例为公共保险，农村地区和保险之间没有显著关联。与非农村地区患者相比，农村地区患者更常见为白人，较少依赖呼吸机，更有可能出院回家而不是入住护理机构。公共保险患者更常见为非白人。28%的患者在出院后 30 天内再次入院。在控制气管切开术时的年龄、性别、种族和呼吸机依赖后，农村患者的 30 天再入院风险较低（比值比 [OR]：0.80，95%置信区间 [CI]：0.68-0.95，p=0.01），但公共保险患者的风险较高（OR：1.24，95% CI：1.09-1.42，p=0.001）。农村地区患者的气管切开术相关入院风险无差异，但公共保险患者的风险较高（OR：1.39，95% CI：1.03-1.88，p=0.03）。
气管切开术后 30 天内再入院的可能性在公共保险患者中更高，在农村患者中更低。这些发现有助于在考虑出院计划和随访时确定高危患者。需要进一步研究这些群体的长期气管切开术结局。
