title: Hospitalizations in children with preexisting tracheostomy: a national perspective.
abstract: OBJECTIVE
  To describe the reasons for hospitalization and characteristics of children with preexisting tracheostomy and to compare hospital utilization between children with and without tracheostomy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Children with tracheostomy were selected in the Healthcare Cost and Utilization Project Kids' Inpatient Database 2009 using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We compared hospital utilization with the children's clinical characteristics (e.g., chronic condition number and type). We also assessed hospitalizations for tracheostomy complications and ambulatory care sensitive conditions (ACSCs) that could be potentially influenced by high-quality outpatient and community care delivery.
  
  
  RESULTS
  In 2009, there were 21,541 hospitalizations for children with tracheostomy totalling $1.4 billion (U.S.). On average, children with tracheostomy had five chronic conditions (standard deviation 1.4). Eighty-one percent (n = 17,448) had one or more complex chronic conditions (CCCs), and 67.1% (n = 14,379) had a gastrostomy. Among children with one or more CCCs, mean hospital charges were greater for hospitalizations of children with tracheostomy compared to without ($69,999 vs. $64,017, P = 0.008). Twenty-one percent (n = 4,421) of all hospitalizations of children with tracheostomy were due to an ACSC (14.5%, n = 3,122) or a tracheostomy complication (6.0%, n = 1,299). Bacterial pneumonia (9.6% of all hospitalizations, n = 2,059) was the most common ACSC.
  
  
  CONCLUSIONS
  Children with tracheostomy are a vulnerable group of children with multiple CCCs who experience lengthy and costly hospitalizations. Many hospitalizations are due to an ambulatory care sensitive condition or a tracheostomy complication. Further investigation is needed to determine whether some of these hospitalizations may be avoidable with improved outpatient and community tracheostomy care.
  
  
  METHODS
  2b.
authors.affiliation: Department of Paediatrics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge.
authors.forename: Hannah
authors.initials: H
authors.lastname: Zhu
authors.forename: Preety
authors.initials: P
authors.lastname: Das
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
authors.forename: Jisun
authors.initials: J
authors.lastname: Jang
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Skinner
authors.forename: Melody
authors.initials: M
authors.lastname: Paine
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yuan
authors.forename: Jay
authors.initials: J
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014139:Tracheostomy; D014481:United States; D055815:Young Adult
keywords: Tracheostomy; complication; pediatric