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Hospital type and experience affect outcomes of children who undergo tracheotomy

Pediatric tracheotomy is a relatively infrequent procedure performed most often on young children who have chronic airway obstruction caused by congenital anomalies or pulmonary disorders or on adolescents with injuries. Children who undergo tracheotomy in a children's hospital have half the risk of dying during their hospital stay compared with children who are cared for in a non-children's hospital, according to a study supported in part by the Agency for Healthcare Research and Quality (K08 HS00002). The study was conducted by researchers at the University of Washington, Seattle, and the Children's Hospital and Regional Medical Center, also in Seattle.

The researchers also found that children cared for in children's hospitals or in teaching hospitals were significantly less likely to be discharged to a long-term care facility, perhaps because these hospitals have more resources or place greater emphasis on discharge coordination and planning than other hospitals. Also, hospitals that performed more pediatric tracheotomies had significantly lower mortality rates than hospitals that performed fewer of these surgeries. The mean length of hospital stay for children undergoing tracheotomy was 50 days, with a mean total hospital charge exceeding $200,000.

Finally, more of these surgeries were performed in the Northeast (7.5 tracheotomy-related discharges per 100,000 child-years) than in other parts of the country. These regional differences suggest that factors aside from the children's health status may be affecting the surgery decision, according to the researchers. They examined tracheotomy rates and patient outcomes using hospital discharge records from all pediatric tracheotomy admissions in 22 States in 1997. The 2,065 tracheotomy procedures recorded in the Healthcare Cost and Utilization Project Kids' Inpatient Database yielded a national estimate of 4,861 tracheotomies performed that year.

See "Tracheotomy in pediatric patients: A national perspective," by Charlotte W. Lewis, M.D., M.P.H., Jeffrey D. Carron, M.D., Jonathan A. Perkins, D.O., and others, in the May 2003 Archives of Otolaryngology and Head and Neck Surgery 129, pp. 523-529.

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