Hospitalization Costs of Pediatric Tracheostomy Patients: Examining Direct Expenses in the Initial Care Period

Sunday, September 29, 2024

8:30 AM – 8:36 AM EDT

Location: MBCC, 225

Disclosure(s):

Romaine F. Johnson, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Yann-Fuu Kou, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Cynthia S. Wang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Rebecca C. Lee, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: This study examines the direct cost of the index stay for children who undergo tracheostomy placement.

Methods: A prospective analysis was conducted on 333 pediatric tracheostomy patients from 2015 to 2022. Using robust regression, heteroskedasticity-adjusted regression, and generalized linear models (GLM), we explored cost relationships with length of stay (LOS), ICU days, age, ventilator time, and severity indicators like sepsis and ECMO.

Results: The cohort's median age was 0.5 months (IQR: 1-75 months), with a majority being male (53%, N = 162). Robust regression, effectively predicting average costs, identified total LOS as a major cost driver, where each additional day increased costs by $7143 (95% CI = $6,644 - $7642, p < 0.001). Notably, sensitivity analyses revealed that preoperative LOS had a more pronounced impact on costs compared to postoperative LOS. Other significant cost influencers included ICU days (β = $1152, p < 0.001), sepsis diagnosis (β = $186,914, p < 0.01), and ECMO usage (β = $31,828, p < 0.01). The model accounted for 92% of the variance in costs but was less effective in predicting costs for short stays ( < 30 days). Alternative models like GLM tended to overestimate costs, particularly in cases with higher complexity. The findings underscore the potential for cost-reduction strategies focused on minimizing preoperative LOS.

Conclusions: Prolonged LOS, intensive care, and complex conditions notably drive costs in pediatric tracheostomy care. Optimizing preoperative LOS, alongside clinical and operational strategies, is essential for reducing healthcare expenditures.

Presenting Author(s)

Romaine F. Johnson, MD, MPH

Professor
Univ of Texas Southwestern Med Ctr
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Romaine F. Johnson, MD, MPH

Professor
Univ of Texas Southwestern Med Ctr
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Stephen R. Chorney, MD, MPH

Assistant Professor, Department of Otolaryngology-Head & Neck Surgery
University of Texas Southwestern Medical Center
Dallas, TX, United States

Disclosure information not submitted.
Yann-Fuu Kou, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Cynthia S. Wang, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Rebecca C. Lee, MD

Resident
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.