Risk factors associated with unplanned readmissions and frequent emergency department visits after pediatric tracheostomy: a nation-wide inpatient database study in Japan

doi:10.21203/rs.3.rs-4941267/v1

Purpose

Children who undergo tracheostomy sometimes experience unexpected readmissions and frequent emergency department (ED) visits. Revealing the risk factors of medical resource use may help improve health outcomes. This study aimed to describe the clinical features of children who underwent tracheostomy and to determine the risk factors associated with unplanned readmission and frequent out-of-hour ED visits.

Methods

Data of children aged between 0 and 18 years who underwent tracheostomy and were discharged between April 2016 and March 2019 were retrieved from the Japanese National Inpatient Database and retrospectively analyzed. Risk factors for readmission and frequent out-of-hour ED visits within 180 days of tracheostomy were estimated using multiple logistic regression analysis.

Results

A total of 1112 patients underwent tracheostomy during the study period. A total of 483 (43%) patients were readmitted and 220 (20%) visited the ED frequently. The multiple logistic regression analysis showed that less than 1 years-of-age (Odds ratio [OR]:1.77; 95% confidence interval [CI]:1.26–2.47; p < .05), tube feeding (OR:1.36; 95% CI:1.03–1.80; p < .05), neuro-impairment (OR:1.52; 95% CI:1.02–2.25; p < 05), and mechanical ventilation (OR:1.94; 95% CI:1.29–2.92; p < .05) were risk factors for readmissions. Moreover, less than 1 years-of-age (OR:1.53; 95% CI:1.03–2.27; p < .05), home oxygen therapy (OR:1.94; 95% CI: 1.29–2.92; p < .05), and unplanned tracheostomy (OR:2.38; 95% CI: 1.05–5.40; p < .05) were risk factors for ED visits.

Conclusions

This study describes the clinical features and risk factors for readmission and frequent out-of-hour ED visits after tracheostomy. This study may help improve health outcomes, healthcare plans, and evidence-based policymaking.

tracheostomy

readmission

emergency department visits

complications

health outcomes

The use of tracheostomy in children with medical complexity has increased, and these children are known to be frequent users of medical resources.
Multicenter studies dealing with the long-term outcomes of pediatric tracheostomy and risk factors associated with high medical resource use are still limited.

What is New:

Using the nationwide database in Japan, this study identified several risk factors associated with unplanned readmissions and out-of-hours emergency department visits (less than 1 years of ages, dependent on medical technologies, etc.).
This study contributes for coordinating appropriate home care plans and reducing preventable medical resource use.

Tracheostomy is performed in patients with upper airway obstruction or respiratory failure requiring long-term ventilator support [1; 2]. In particular, the use of tracheostomy for children with medical complexity (CMC), such as children with neuro-impairments (NIs) who require home ventilator support, has increased [3–5].

A previous study reported that hospitalized CMCs accounted for less than 1% of the population; however, they required one-third of the medical costs of pediatric hospitalizations [6]. The American Academy of Pediatrics recommends the importance of evaluating unplanned hospitalizations and emergency department visits for quality-improvement of the health care system around CMCs. [7]. In recent years, the understanding of these high medical utilizers and improvement of care coordination has grown because of their potential to improve outcomes and reduce unnecessary medical healthcare utilization [8].

Among CMCs who have severe and complex conditions or require ventilators, many visit the emergency department (ED) and are readmitted in the short term after tracheostomies [9; 10]. These reports indicate that children who undergo tracheostomy require the frequent use of medical resources. They were hospitalized for various reasons, including aspiration pneumonia and complications related to tracheostomy.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation recognizes the need to investigate risk factors for readmission and ED visits after tracheostomy [8]; however, the evidence is limited. A few multicenter studies deal with the outcomes of tracheostomy [9; 10] and a few reports investigate the risk factors for readmissions and frequent long-term ED visits after tracheostomy [4; 9; 10]. Hence, there is limited information on a large cohort of multicenter epidemiological data and the long-term outcomes of children who underwent tracheostomy in Japan [11]. Revealing the clinical features and risk factors of medical resource use in children is beneficial for improving health outcomes and healthcare plans [12; 13].

Therefore, this study aimed to describe the clinical features of children who underwent tracheostomy in Japan and to determine the risk factors for unplanned readmission and frequent out-of-hour ED visits after index hospitalization when tracheostomies were performed using the Japanese administrative database.

The cohort for this retrospective study was identified using the Japanese Administrative Database, Diagnosis Procedure Combination/per-diem payment system (DPC/PDPS). This database is a case-mix patient classification system linked to payments at acute care hospitals in Japan since 2003. Details of this database have been described previously [14; 15]. The DPC/PDPS covered 1730 hospitals and 488563 beds in 2018, and almost all acute inpatients were included, accounting for more than half of the 894,000 hospital beds in Japan [14; 16].

Patient clinical and administrative claims data were collected annually from hospitals. This database included information on: age; sex; diagnostic information using the International Statistical Classification of Diseases, Tenth Revision (ICD-10) code; all procedures; medical device use; medications; purpose of admission; duration of admission; outcome at discharge; and discharge destination. This database also included hospital information regarding the number of beds for pediatric patients.

This study was approved by the Institutional Review Board of the Tokyo Medical and Dental University (M2024-075). The board determined that informed consent was not required because the data were anonymized.

We recruited children aged between 0 and 18 years who underwent tracheostomy (Japanese operative code: K386-00) and were discharged from Japanese hospitals between April 2016 and March 2019 to avoid the effect of the COVID-19 pandemic. Hospitalizations in which the patient underwent tracheostomy for the first time were defined as index hospitalizations. Patients who died during the index hospitalization, underwent tracheostomy closure (K396-00) during the index hospitalization, were transferred to other hospitals and post-acute care facilities, or were scheduled to visit other hospitals were excluded.

The primary outcome was unplanned readmission for treatment within the same hospital during the first 180 days after the index hospitalization in patients who had undergone a tracheostomy. We only dealt with readmissions for treatment because CMCs sometimes use respite admissions after significant changes, such as starting mechanical ventilation in Japan. In general, complex cases are associated with background diseases and various conditions, leading to longer hospital stays and more visits and readmissions. As a large number of CMCs were expected in our cohort, we followed up for a longer period. We set the follow-up period at 180 days because the characteristics of DPC may not have been successfully followed up for a follow-up period of approximately 1 year. Our database included 30 days of unplanned readmissions data. We did not include details of the unplanned readmissions data between 31 and 180 days because there was no need to record whether readmissions during this period were planned or not in this database. Unplanned readmissions from 31 to 180 days after the index hospitalization were defined as flags of unplanned readmissions or emergent readmissions to treat at readmission because we had to rule out readmissions for respite as much as possible. Readmission was categorized using the ICD-10. The secondary outcome was the frequency of ED visits within the same hospital during the first 180 days after index hospitalization. Frequent out-of-hour ED visits were defined as two or more night/holiday ED visits according to previous reports [10; 17; 18].

Individual- and hospital-level data were collected from the DPC and PDPS. Individual data included: age, sex, ICD-10 diagnosis, procedures, medical device use at discharge, length of hospital stay, admission status (planned or unplanned), purpose of admission, outcome at discharge, discharge destination, and the distance between the hospital and patient.

Comorbidities were categorized into five groups according to previous studies: upper airway anomaly, neurological impairment, prematurity, trauma, and others [9; 19–21] (Supplemental table 1). Respiratory support was categorized according to the degree of support, as follows: non-respiratory support, only home oxygen therapy (HOT) use, or home respirator use (with or without HOT). Tube-nutrition use included children who used all types of tube feeding, with or without gastrostomy. The diagnosis at readmission was categorized into five groups according to previous studies: respiratory, digestive, nervous system, infectious, and other [9; 10].

Tracheostomy complications were defined as ‘Tracheostomy complications’ (J950) and ‘Hemorrhage from other sites in the respiratory passages’ (R048), based on ICD-10 codes. We used the Manhattan distance as the scale of the distance between the hospital and the patient’s home. Because some samples had no Manhattan distance data, we recruited straight-distance data. The indicator of bed size of the Pediatric ward was divided into lowest quartile (< 1652 pediatric patients/year), interquartile (1652–3137 pediatric patients/year), and highest quartile (≥ 3137 pediatric patients/year). The clinical course classification was separated into three categories: planned tracheostomy (planned admission and receiving tracheostomy within 3 days after admission), tracheostomy during hospitalization after birth (admission within 0–7 days-of-age), and unplanned tracheostomy (patients not eligible for the other two categories).

Continuous variables are presented as medians and interquartile ranges (IQRs) or means ± standard deviations (SDs), depending on their distribution.

Group comparisons between the readmission and non-readmission groups and between groups with and without frequent after-hour visits were analyzed using Pearson's chi-square test and the Kruskal-Wallis’s test. Multivariate logistic regression was used to estimate predictors associated with 180-day unscheduled hospital readmissions and after-hour ED visits. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). All analyses were two-tailed, and p-values less than .05 were considered statistically significant. Multicollinearity between covariates was determined using the variance inflation factor and tolerance values. All analyses were performed using EZR version 1.54.33.

3.1 Participant characteristics

A total of 2308 patients underwent tracheostomy during their index hospitalization in Japan between April 2016 and March 2019 (Figure 1). After excluding patients who met the exclusion criteria, 1112 patients were discharged to their homes and scheduled to visit the same hospital. There were no significant differences in characteristics between the study cohort and the excluded patients. Table1 shows the characteristics of the study cohort. The median age at index hospitalization was 0 years (IQR:0-6 years), and 601 patients (54%) were under 1 year old. The most common comorbidity associated with tracheostomy was NI (69%), followed by upper airway anomalies (21%), and prematurity (18%). More than 60% of patients depended on respiratory support, and 45% used feeding tubes at discharge from their index discharge. Tracheostomy-related complications occurred in eight patients. The most common clinical course was an unplanned tracheostomy (63%).

3.2 Unplanned readmissions within 180 days of tracheostomy

Among the 1112 patients, 374 (34%) were readmitted within 180 days of tracheostomy (Table 2). Children readmitted within 30 days were the most common group (172/374 patients). Fifteen percent were readmitted within 30 days, 25% within 90 days, and 32% within 150 days of tracheostomy. The readmission group was younger than the non-readmission group (p<.05) and less than 1 years of age was more common in the readmission group than the non-readmission group (62% vs. 50%, respectively; p<.05). Tube nutrition at discharge was more common in the readmission group than in the non-readmission group (p<.05). Among the comorbidities, trauma was less common in the readmission group than in the non-readmission group (1% vs. 5%,respectively; p<.05). The most common reason for readmission was a respiratory disorder (54%), followed by a nervous system disorder (20%). The incidence of tracheostomy-related complications during readmission was only 12 cases (2%) (Table 3).

Figure 2 shows the multiple logistic regression analysis of the odds of readmission within 180 days after tracheostomy. We found that age less than 1 year (OR:1.77; 95% CI:1.26-2.47; p<.05), tube feeding (OR:1.36; 95% CI:1.03-1.80; p<.05 ), NI (OR:1.52; 95% CI:1.02-2.25; p<.05), and ventilation support (OR: 1.94; 95% CI: 1.29-2.92; p<.05)) were risk factors associated with readmission within 180 days after tracheostomy.

3.3 Frequent out-of-hours ED visits within 180 days of tracheostomy

Among the 1112 patients, 220 (20%) frequently visited the ED within 180 days of tracheostomy (Table 2). This group was younger than the group with no frequent ED visits (p<.05) and being less than 1 years old was also more common in this group than the group with no frequent ED visits (64% vs. 52%, respectively; p<.05). Using multiple logistic regression analysis (Figure 3), we found that age less than 1 year (OR:1.53; 95% CI:1.03-2.27; p<.05), HOT (OR:1.94; 95% CI: 1.29-2.92; p<.05), a hospital distance of 20.7 km or less (OR:0.41; 95% CI:0.25-0.66) , and unplanned tracheostomy (OR:2.38; 95% CI: 1.05-5.40; p<.05) were associated with out-of-hours ED visits 180 days of tracheostomy.

To the best of our knowledge, this is the first nationwide study on unplanned readmission and out-of-hour ED visits among children who underwent tracheostomy in Japan. This study adds to previous studies by analyzing risk factors for readmissions and out-of-hour ED visits, considering not only factors related to patient characteristics but also other factors that may affect medical resource use, such as differences between hospitals based on bed size, distance to hospitals, and type of clinical course.

We found that 20% of patients were readmitted within 90 days after tracheostomy, and more than 40% of patients were readmitted within 180 days after index hospitalization. While most previous studies were conducted over a short period, our results highlight the importance of long-term follow-up for children who undergo tracheostomy. The characteristics of our study cohort were similar to those in previous reports, with half of the cases being less than 1 years old, approximately 40% on mechanical ventilators and tube feeding, and almost 70% having NIs. Surprisingly, more than 60% of the tracheostomies were unplanned, which has not been reported previously. Appropriate assessment of tracheostomy and daily care in cases of deteriorating health conditions is important. Guidelines on the indications for pediatric tracheostomy in chronic conditions are required.

The most common cause of readmission was respiratory-related diseases, and the frequency of tracheostomy-related complications was low in our cohort. This is similar to the low frequency of tracheostomy complications in previous reports, and readmissions for respiratory-related diseases, such as respiratory failure and airway infection, being the most common causes of readmissions [4; 9; 10]. This indicates the importance of expectoration, education of care, and prevention of respiratory infection among CMCs.

Compared with previous studies, the readmission rates were lower than those in other developed countries: 30 days (17% vs. 18–45%, respectively) [1; 9; 22], 90 days (25% vs. 44%, respectively) [4], and 180 days (34% vs. 63–66%, respectively) [10; 23] after tracheostomy. This is partly because this study was limited to readmissions to the same hospital and readmissions for treatment, which may have underestimated hospitalization rates. Moreover, differences in the indications for tracheostomy, discharge criteria, and healthcare systems may have influenced this disparity. Furthermore, most studies did not consider avoidable or unavoidable readmissions. Owing to the internationally high readmission rates from long-term assessments, further studies on unavoidable readmissions and long-term outcomes are required.

Less than 1 years of age, NI, tube feeding, and ventilation support were identified as risk factors associated with readmission within 180 days after tracheostomy. Infants and mechanical ventilators have been reported to be risk factors for readmission and frequent resource use in previous reports [10; 19; 24]. In the case of infants, because they are known to be immunologically vulnerable and their caregivers have just started to raise their child and are often unfamiliar with care, even if they have no medical technologies, they are potentially at risk of using hospital resources. Complex cases, such as those with NIs and children depending on medical technology, are known to use a large proportion of medical resources [6; 9]. For these children, it is advisable to prepare sufficient care training and dense care plans, such as home-visiting nurses or doctor plans, before initial discharge [25; 26].

In our cohort, 220 (20%) patients visited the ED within 180 days of

tracheostomy. Frequent ED visits are reportedly associated with readmission [18]. The risk factors tended to be similar to those for readmission, although children using only HOT had a higher risk of ED visits compared with those on mechanical ventilation, and patients living far from the hospital had a lower risk of ED visits. Since it has been reported that patients with long distances to hospitals often visited multiple hospitals [17], it is possible that the frequency of visits was underestimated in this study. Additionally, because severely complex cases, such as children depending on home ventilators, are often supported by home-visiting doctors and nurses in Japan, home ventilators may not be a risk factor for ED visits.

We also found that unplanned tracheostomy was associated with a higher risk of frequent out-of-hour ED visits than planned cases. While guidelines for the management of pediatric patients undergoing tracheostomy in the acute care setting exist [27], there has been no evidence of an association between the clinical course before tracheostomy and hospital resource use. Further research is needed to identify why unplanned tracheostomy are performed and why ED visits are frequent, which may reveal important factors in addressing this issue. In children with unstable airways, tracheostomy after appropriate evaluation during non-emergency conditions reduces the risk of frequent out-of-hour ED visits.

Less than 1 years of age was a common risk factor, and children depending on medical technologies have some risk of medical resource use. Emergency visits and subsequent hospital admissions have been reported to increase the length of hospital stay and lead to increased costs [28]. It is important to provide close care planning and patient education for children with these risk factors to minimize the use of medical resources, not only to improve patients’ health outcomes and quality of life but also to address the issue of social costs. Furthermore, the care of children with medical technology, such as tracheostomy independence, places a heavy burden on families [29]. Further research into the needs of the family is required as it is necessary to secure personnel and improve the uneven distribution of home medical care in order to expand the welfare system and services so that the burden is not placed solely on the family to provide care.

This study had a few limitations. First, due to the characteristics of this database, we were only able to track readmissions and visits to the same hospital. However, CMCs are generally less likely to be transferred to other hospitals; hence, we focused on patients who planned on attending outpatient clinics at the same hospital as the discharge destination. Second, disease classification was based on previous reports as there is no validated classification of diseases. Third, we were unable to obtain detailed information on the characteristics of the home ventilator, and we did not have data on the family background environment (structure, income, and educational standards of their parents). Fourth, regional differences in the density of support by home-visiting doctors and nurses may have been associated with readmissions; however, we could not account for this because we did not have detailed data on home care medicine. Fifth, we selected unplanned admissions among readmissions within 30 days after tracheostomy; however, between 31 and 90 days after the index discharge, we used admissions for treatments in the absence of the same information, which may have included a small number of admissions for respite. Finally, our database system did not capture daytime ED visits, and there were no data on the reasons for these visits; therefore, we were unable to investigate them.

We found that 43% of children required unplanned readmission after tracheostomy, and 20% experienced frequent out-of-hour ED visits 180 days of tracheostomy. We identified age less than 1 year, tube feeding, neuro impairment and ventilation support as risk factors associated with readmission, and we also revealed that age less than 1 year, HOT, and a hospital distance of 20.7 km or less, unplanned tracheostomy as risk factors associated with ED visits. Estimating these risk factors before the index discharge would be helpful in coordinating appropriate home care plans and reducing preventable medical resource use. This study may help improve health outcomes, healthcare plans, and evidence-based policymaking. Further research accounting for additionally factors may be required to validate our findings.

CMC; children with medical complexity, Cis; confidence intervals, ED; emergency department, HOT; home oxygen therapy, IQRs; medians and interquartile ranges, NI; neuro-impairments, ORs; odds ratios, SDs; standard deviations

Statements and Declarations

The authors have no relevant financial or non-financial interests to disclose.

Data availability statements

Data cannot be disclosed to the public due to a license agreement and ethical issues in each participating facility. To request the dataset generated during this study, please contact the Office of Life Science and Bioethics Research Center via: Email:[email protected] Telephone: +81-3-3813-6111. The corresponding author is also available for data requests.

Acknowledgements

We would like to thank everyone involved in the study at the National Center for Child Health and Development and Tokyo Medical and Dental University for their cooperation. We are also grateful to Dr. Takahisa Watabe of Division of Otolaryngology of the National Center for Child Health and Development for his continuous support.

Funding

Funding for this research was provided by a Grant-in-Aid for Policy Planning and Evaluation Research from Japan’s Ministry of Health, Labour and Welfare (grant identifier 22AA2003 [awarded to KF]) and a Grant-in-Aid for Scientific Research (B) through the Japan Society for the Promotion of Science (JSPS KAKENHI, grant identifier 24K02666 [awarded to DS]). The funders did not influence the design or conduct of the study, the gathering or interpretation of data, the decision to submit the results for publication, or the drafting of the research paper.

Contributions

Ai Ito-Shinjo: Conceptualization, data curation, methodology, formal analysis, and writing of the original draft. Daisuke Shinjo: Conceptualization, methodology, review writing, editing, project administration, and funding acquisition. Kiyohide Fushimi: Supervision, resources, review writing, and funding acquisition. All authors reviewed, edited and approved the final manuscript.

Ethics declarations

Ethical approval

This study was performed in accordance with the Declaration of Helsinki. This study was conducted retrospectively using the Japanese Administrative Database. This study approved by the Institutional Review Board of the Tokyo Medical and Dental University (M2024-075). The board determined that informed consent was not required because the data were anonymized.

Competing interests

The authors declare no competing interests.

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Table 1. Characteristics of the study cohort.

Characteristics	Total N=1112
Age, years, median (IQR)	0 (0-6)
<1 years old, n (%)	601 (54)
Male, n (%)	596 (54)
Comorbidities associated with tracheotomy, n (%)
A Upper airway anomaly	233 (21)
B Neurologic impairment	762 (69)
C Prematurity	200 (18)
D Trauma	42 ( 4)
E Others	163 (15)
Respiratory support at discharge, n (%)
None	432 (39)
Home oxygen therapy	259 (23)
Ventilation support	421 (38)
Tube nutrition at discharge, n (%)	495 (45)
Complication of tracheostomy, n (%)	8 ( 1)
Number of pediatric admissions*, n (%)
＜1652/year	279 (25)
1652-3137/year	568 (51)
≥ 3137/year	265 (24)
Distance between home and hospital, n (%)
＜4.9 km	276 (25)
4.9-20.7 km	553 (51)
≥ 20.7 km	275 (25)
N/A	8 ( 1)
Clinical course classification, n (%)
Planned tracheostomy	80 ( 7)
Tracheostomy during hospitalization of after birth	333 (30)
Unplanned tracheostomy	699 (63)
Length of stay, days, median (IQR)	113 (58-221)
Readmission within 180 days, n(%)	374 (34)
Frequent out-of-hours ED visits in 180 days, n (%)	220 (20)

IQR, interquartile range; ED, emergency department

* The number of pediatric admissions was calculated using the number of pediatric patients per year as an indicator of the bed size of the ward for children.

Table 2. Variables associated with readmission and frequent out-of-hours ED visits within 180 days of tracheostomy according to groups.

Variables	Readmission N=374	Non-readmission N=738	p-value	≧2 visits N=220	＜2 visits N=892	p-value
Age, years, median (IQR)	0 (0-3.0)	0 (0-8.0)	<0.05	0 (0-2.0)	0 (0-8.0)	<0.05
<1 year-old, n (%)	231 (62)	370 (50)	<0.05	140 (64)	461 (52)	<0.05
Male, n (%)	196 (52)	400 (54)	0.61	118 (54)	478 (54)	1.00
Comorbidities associated with tracheotomy, n (%)
A Upper airway anomaly	76 (20)	157 (21)	0.76	60 (27)	241 (27)	0.93
B Neurologic impairment	284 (76)	478 (65)	<0.05	156 (71)	606 (68)	0.42
C Prematurity	63 (17)	137 (19)	0.51	43 (20)	157 (18)	0.49
D Trauma	5 ( 1)	37 ( 5)	<0.05	4 (1.8)	38 (4.3)	0.11
E Others	43 (12)	120 (16)	<0.05	28 (13)	135 (15)	0.30
Respiratory support at discharge, n (%)			<0.05			<0.05
None	110 (29)	322 (44)		63 (29)	369 (41)
Only home oxygen therapy	167 (23)	92 (25)		71 (33)	188 (21)
Ventilation support	172 (46)	249 (34)		86 (39)	335 (38)
Tube nutrition at discharge, n (%)	202 (54)	293 (40)	<0.05	110 (50)	385 (43)	0.07
Length of stay of initial admission, days, median (IQR)	133 (64-240)	107 (53-212)	<0.05	112 (56-213)	113 (58-222)	0.93
Number of pediatric admissions, n (%)			0.82			0.10
＜1652/year	95 (25)	184 (25)		61 (28)	215 (24)
1652-3137/year	185 (50)	383 (52)		129 (59)	424 (48)
≥ 3137/year	94 (25)	171 (23)		63 (29)	202 (23)
Distance between home and hospital, n (%)			<0.05			<0.05
＜4.9 km	108 (29)	168 (23)		61 (28)	215 (24)
4.9-20.7 km	190 (51)	363 (49)		129 (59)	424 (48)
≥ 20.7 km	74 (20)	201 (27)		30 (14)	245 (28)
N/A	2 ( 1)	6 ( 1)		0 ( 0)	8 ( 1)
Clinical course classification, n (%)			0.11			<0.05
Planned tracheostomy	61 ( 8)	19 ( 5)		7 ( 3)	73 ( 8)
Tracheostomy during hospitalization of after birth	120 (32)	213 (29)		76 (35)	266 (30)
Unplanned tracheostomy	235 (63)	464 (63)		137 (62)	553 (62)

IQR, interquartile range

Table 3. Clinical features of patients with readmissions within 180 days of tracheostomy.

Clinical features	Total N=374
Length of stay of readmissions, days, median (IQR)	9.0 (5.0-16.0)
Reason for readmissions, n (%)
Respiratory	246 (66)
Digestive	10 ( 3)
Nervous system	28 ( 7)
Infectious	20 ( 5)
Others	70 (19)
Complications of tracheostomy, n (%)	10 ( 3)

IQR, interquartile range

No competing interests reported.

TableS1.docx

Risk factors associated with unplanned readmissions and frequent emergency department visits after pediatric tracheostomy: a nation-wide inpatient database study in Japan

Status:

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Abstract

Purpose

Methods

Results

Conclusions

Figures

What is Known

1. Introduction

2. Material and methods

3. Results

3.1 Participant characteristics

3.2 Unplanned readmissions within 180 days of tracheostomy

3.3 Frequent out-of-hours ED visits within 180 days of tracheostomy

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1