title: Pediatric tracheostomies: a recent experience from one academic center.
abstract: OBJECTIVE
  To describe the indications, surgical timing, length of stay, hospital charges, and discharge disposition of pediatric tracheostomy patients.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Large urban academic pediatric hospital.
  
  
  METHODS
  Seventy children and adolescents undergoing tracheostomy placement over a 24-month period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Hospital database records were used to determine demographics and readmission rates, tabulate charges, and confirm deaths. Indications for tracheostomies included airway obstruction, inadequate airway protection, chronic lung disease, neuromuscular weakness, and central hypoventilation. Surgical timing of the tracheostomy was grouped into three categories: prolonged mechanical ventilation, elective, or emergent. The overall median hospital stay was 46 days (range 14-254) with a median hospital charge of $136,718 (range $36,237-$913,934). The prolonged mechanical ventilation group underwent a tracheostomy after a median of 26 days (mean 37.5 days) on the ventilator. Eighty-one percent of children were discharged home; 63% of children were readmitted within 6 months, with 11% requiring four or more admissions. The six-month mortality rate was 13%; no deaths were related to the tracheostomy.
  
  
  CONCLUSIONS
  Children with tracheostomies are a heterogeneous population. Children who require tracheostomy for long-term mechanical ventilation have longer hospital stays than children who receive a tracheotomy on an elective or emergent basis. Hospital readmissions should be anticipated in this complex group of patients.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. jgraf@bcm.edu
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Graf
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Montagnino
authors.forename: Remí
authors.initials: R
authors.lastname: Hueckel
authors.forename: Mona L
authors.initials: ML
authors.lastname: McPherson
mesh_terms: D000046:Academic Medical Centers; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013781:Texas; D014139:Tracheostomy / Q000009:adverse effects / Q000191:economics / Q000379:methods