O2084: Factors Associated with 7-day Hospital Readmission After Tracheostomy Associated Respiratory Infection: A Multicenter Retrospective Cohort Study

Background: Children with tracheostomy are frequently readmitted after inpatient treatment for tracheostomy-associated respiratory infections (TARIs). Several risk factors have been identified for readmission within 30 days of discharge. However, this timeframe may reflect newly acquired conditions and miss opportunities for improving inpatient care. Therefore, we aimed to explore factors associated with 7-day hospital readmission among patients treated for TARI.

Methods: We conducted a multicenter retrospective cohort study using the Pediatric Health Information System (PHIS) database. De-identified data for inpatient encounters from 48 freestanding children’s hospitals were obtained for children with tracheostomy 0-21 years of age, hospitalized with principal diagnoses consistent with TARI (e.g. pneumonia, tracheitis) between 1/1/2017 to 1/31/2024. Encounters with mortality or planned readmissions were excluded. Our primary outcome was all-cause hospital readmission within 7 days of discharge. Demographic factors, diagnostic evaluation, and medical care received during the index hospitalization were extracted from PHIS and compared between patients with and without readmission. We explored the associations between demographic, diagnostic evaluation, and inpatient treatment factors and our primary outcome using multivariable logistic regression. Additionally, we assessed for differences in index and readmission hospital lengths of stay and total encounter charges adjusted for region and inflation (to 2023 US dollars) using non-parametric testing.

Results: Readmission occurred in 1,181/17,783 (6.6%) of TARI encounters, ranging from 0-11.3% across sites (Fig. A). Demographic, diagnostic, and hospital course data are summarized in Tables 1 and 2. The median (IQR) age at admission was 5 (2-11) years and 83% of encounters had ≥3 chronic complex conditions. Respiratory pathogen (84%) and inflammatory marker (54%) testing were frequently obtained (Fig. B). Systemic antibiotics were prescribed in 92% of encounters (Fig. C). Encounters with a readmission had a longer median [IQR] index length of stay (6 [3-11] vs. 5[3-10]; p=.008). In multivariable analysis (Fig. D), older age, receipt of inhaled corticosteroids, and viral TARI diagnosis were associated with reduced odds of readmission. Inflammatory marker testing and antacid prescription were associated with increased odds of readmission. Although 73% (n=868) of principle diagnoses of the readmission encounters were for different causes, the most frequent diagnosis categories remained related to the respiratory system (52%). Index and readmission encounter LOS did not differ (difference of median [IQR] 0 [(-5)-4] days; p=.22) and 77% of readmission encounters were longer than 2 days. Similarly, index and readmission total encounter charges did not differ in this cohort ($182,720 vs. $180,804; p=.35).

Conclusion: Nearly 1 in 14 TARI hospitalizations resulted in 7-day readmission. Patients with viral TARIs may be at reduced odds of readmission due to the self-limiting nature of viral illness. Antibiotic and anti-inflammatory treatment was common in TARI encounters with variable effects on readmission. Future research to optimize pre-discharge care, including the role of specific pharmacological interventions is warranted.