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Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions
Jay G Berry1,2, Rachel L Difazio2,3, Patrice Melvin4
1Complex Care Service, Division of General Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Insights
Co-occurring conditions significantly impact recovery for children with neurological complex chronic conditions (CCCs) undergoing hip reconstruction. Malnutrition is a key risk factor for prolonged hospital stays and increased resource use.
Area of Science:
- Pediatric Orthopedics
- Complex Chronic Conditions (CCCs)
- Healthcare Outcomes Research
Background:
- Children with neurological CCCs frequently experience hip disorders requiring surgical intervention.
- Co-occurring chronic conditions are prevalent in this pediatric population, potentially complicating surgical recovery.
Purpose of the Study:
- To evaluate the influence of co-occurring conditions on recovery outcomes after hip reconstruction surgery in pediatric patients with neurological CCCs.
- To identify specific co-existing conditions that may predict prolonged hospital stays, increased costs, or higher readmission rates.
Main Methods:
- Retrospective analysis of 4058 children (≥4 years) with neurological CCCs undergoing hip reconstruction (2015-2018).
- Assessment of co-occurring conditions using the Agency for Healthcare Research Chronic Condition Indicator system.
- Multivariable, hierarchical regression to analyze the association between co-existing conditions and postoperative length of stay (LOS), cost, and 30-day readmission rates.
Main Results:
- Increased number of co-existing conditions correlated with significantly longer median LOS (67% increase), higher median hospital costs (41% increase), and a 250% rise in readmission rates.
- Digestive (60.1%) and respiratory (37.9%) conditions were most common.
- Malnutrition emerged as a significant risk factor, associated with the greatest increase in postoperative hospital resource utilization.
Conclusions:
- Co-occurring conditions, particularly malnutrition, represent a substantial risk factor for prolonged in-hospital recovery and increased resource use following hip reconstruction in children with neurological CCCs.
- Further research into preoperative optimization strategies for co-occurring conditions is warranted to improve surgical outcomes and resource efficiency.
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.
