TOP 28 - The Complications of Tracheostomy in Patients with Bronchopulmonary Dysplasia: Analyzing Readmission and Mortality Risks

Publication Number: 1788.TOP 28

Lucy Emery, Boston Children's Hospital, Boston, MA, United States; Jennifer M.. Perez, Boston Children's Hospital, Boston, MA, United States; Jonathan M. Gabbay, The Children's Hospital at Montefiore, Bronx, NY, United States; Ben Bajaj, Massachusetts General Brigham, Durham, NC, United States; Jonathan C. Levin, Harvard Medical School, Boston, MA, United States; Robert J. Graham, Boston Children's Hospital, Boston, MA, United States

Background: Tracheostomy placement in infants with bronchopulmonary dysplasia (BPD) involves complex decision-making and carries significant implications for long-term outcomes such as readmission and mortality. Following discharge, infants with tracheostomy and BPD continue to experience high healthcare utilization and caregiver burden. These frequent readmissions, coupled with the demands of home mechanical ventilation and tracheostomy care, place substantial emotional, financial, and logistical strain on families. Analyzing risk factors for adverse healthcare outcomes after discharge provides insight into disparities and opportunities for intervention to reduce inequities in care.

Objective: Identify risk factors associated with hospital readmissions and mortality among children with bronchopulmonary dysplasia who undergo tracheostomy.

Design/Methods: Our cohort includes infants with BPD who underwent tracheostomy placement between January 1, 2016 and December 31, 2022 during index admission within the NICU from the Pediatric Health Information System (PHIS) database. The PHIS database is an administrative database that contains inpatient encounters from tertiary children’s hospitals affiliated with the Children’s Hospital Association (Lenexa, KS). After discharge from the encounter during which the tracheostomy was placed, patients will be followed for a two-year period to evaluate adverse healthcare utilization and outcomes. Our primary outcomes are time to first readmission, number of readmissions, and mortality. Secondary outcomes include total healthcare costs and time to decannulation. Descriptive analyses will be used to present demographic and clinical characteristics, and to summarize hospital resource utilization for the cohort. We will assess the associations between patient demographics and clinical factors and our outcomes using the Kaplan-Meier method and semi-parametric modeling for time to event outcomes and generalized linear models for number of readmissions with inclusion of a random effect to account for hospital-level clusters. Center and regional-level variation in timing of tracheostomy placement and decannulation will be assessed via log-rank tests.