title: Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy.
abstract: To assess patient characteristics associated with adverse outcomes in the first 2 years following tracheostomy, and to report healthcare utilization and cost of caring for these children.
  
  
  
  Retrospective cohort study.
  
  
  
  Children (0-16 years) in Medicaid from 10 states undergoing tracheostomy in 2009, identified with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes and followed through 2011, were selected using the Truven Health Medicaid Marketscan Database (Truven Health Analytics, Inc., Ann Arbor, MI). Patient demographic and clinical characteristics were assessed with likelihood of death and tracheostomy complication using chi-square tests and logistic regression. Healthcare use and spending across the care continuum (hospital, outpatient, community, and home) were reported.
  
  
  
  A total of 502 children underwent tracheostomy in 2009, with 34.1% eligible for Medicaid because of disability. Median age at tracheostomy was 8 years (interquartile range 1-16 years), and 62.7% had a complex chronic condition. Two-year rates of in-hospital mortality and tracheostomy complication were 8.9% and 38.8%, respectively. In multivariable analysis, the highest likelihood of mortality occurred in children age < 1 year compared with 13+ years (odds ratio [OR] 7.3; 95% confidence interval [CI], 3.2-17.1); the highest likelihood of tracheostomy complication was in children with a complex chronic condition versus those without a complex chronic condition (OR 3.3; 95% CI, 1.1-9.9). Total healthcare spending in the 2 years following tracheostomy was $53.3 million, with hospital, home, and primary care constituting 64.4%, 9.4%, and 0.5% of total spending, respectively.
  
  
  
  Mortality and morbidity are high, and spending on primary and home care is small following tracheostomy in children with Medicaid. Future studies should assess whether improved outpatient and community care might improve their health outcomes.
  
  
  
  4. Laryngoscope, 126:2611-2617, 2016.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts. karen.watters@childrens.harvard.edu.|Harvard Medical School, Boston, Massachusetts. karen.watters@childrens.harvard.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Watters
authors.affiliation: Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: Department of Pediatrics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Graham
authors.affiliation: Children's Hospital Association, Overland Park, KS, U.S.A.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay
authors.initials: J
authors.lastname: Berry
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Tracheostomy; Truven MarketScan Medicaid Database