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Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions
Author(s) -
Berry Jay G,
Difazio Rachel L,
Melvin Patrice,
Glader Laurie,
Casto Elizabeth,
Shore Benjamin J
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14712
Subject(s) - interquartile range , medicine , malnutrition , resource use , retrospective cohort study , emergency medicine , surgery , natural resource economics , economics
Aim To assess how co‐occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs). Method This was a retrospective analysis of 4058 children age 4 years or older with neurological CCCs who underwent hip reconstructive surgery between 1st January 2015 and 31st December 2018 in 49 children’s hospitals. The presence of co‐occurring chronic conditions was assessed using the Agency for Healthcare Research Chronic Condition Indicator system. Multivariable, hierarchical regression was used to assess the relationship between co‐existing conditions and postoperative hospital length of stay (LOS), cost, and 30‐day readmission rate. Results The most common co‐occurring conditions were digestive (60.1%) and respiratory (37.9%). As the number of co‐existing conditions increased from one to four or more, median LOS increased 67% (3d [interquartile range {IQR} 2–4d] to 5d [IQR 3–8d]); median hospital cost increased 41% ($20 248 [IQR $14 921–$27 842] to $28 692 [IQR $19 236–$45 887]); and readmission rates increased 250% (5.5–13.9%), p <0.001 for all. Of all specific co‐existing chronic conditions, malnutrition was associated with the greatest increase in postoperative hospital resource use. Interpretation Co‐occurring conditions, and malnutrition in particular, are a significant risk factor for prolonged, in‐hospital recovery after hip reconstruction surgery in children with a neurological CCC. Further investigation is necessary to assess how improved preoperative optimization of multiple co‐occurring conditions may improve postoperative outcomes and resource utilization. What this paper adds Children with neurological complex chronic conditions (CCCs) often develop hip disorders which require hip reconstruction surgery. Co‐occurring conditions are common in children with neuromuscular CCCs. Having four or more chronic conditions was associated with a longer length of stay, increased costs, and higher odds of readmission. Malnutrition was a significant risk factor for prolonged hospitalization after hip reconstruction surgery.