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Infantile Hemangioma Treated with Propranolol Readmission Trends, Complications of Therapy, and Cost: A PHIS Database
Muhammad Abu-Rmaileh1, Hayden C Hairston1, Isabella Zaniletti2
1College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Infantile hemangioma (IH) admissions treated with propranolol have declined nationally. Inpatient care may benefit infants with neurologic or respiratory conditions, despite low complication rates.
Area of Science:
- Pediatric Medicine
- Dermatology
- Pharmacology
Background:
- Infantile hemangioma (IH) is a common pediatric vascular tumor.
- Propranolol is a first-line treatment for IH.
- Understanding inpatient trends and outcomes for IH treated with propranolol is crucial.
Purpose of the Study:
- To analyze admission trends, complications, and costs for infantile hemangioma (IH) treated with propranolol.
- To identify factors associated with length of stay and readmission in these patients.
Main Methods:
- Retrospective cohort study using the Pediatric Health Information System (PHIS) database (2008-2020).
- Inclusion criteria: infants aged 3 weeks to 1 year, diagnosed with IH, and treated with propranolol.
- Analysis of admission trends, length of stay, readmission, mortality, complications, and costs.
Main Results:
- A total of 2290 patient encounters were identified, with a decreasing admission trend after 2011.
- Low rates of propranolol-related complications (2.6%) and no mortality were observed.
- Factors associated with increased length of stay included African-American race, respiratory comorbidities, neurologic conditions, ICU admission, bronchospasm, and hyperkalemia. Neurologic and respiratory comorbidities predicted readmission.
Conclusions:
- National inpatient admissions for IH treated with propranolol have declined.
- Inpatient admission may be particularly beneficial for infants with IH who have co-existing neurologic or respiratory conditions.
- Propranolol therapy for IH appears safe in the inpatient setting, with a low complication rate.
Objective:
To examine admission trends, complications, and costs for inpatient infantile hemangioma (IH) associated with propranolol therapy utilizing the Pediatric Health Information System (PHIS) database. Study Design. A retrospective cohort study was completed using the PHIS database. The PHIS database was queried from 2008 to 2020 for children without cardiac disease and between the ages of three weeks and one year who were admitted with a diagnosis of IH and administered propranolol. Admissions were trended annually and by geographic region. Primary outcomes were length of stay (LOS), readmission, mortality, propranolol-related complications, and costs. Bivariate and multivariable analyses were employed to identify predictors of the primary outcomes.
Results:
A total of 2290 unique patient encounters were identified. Admissions steadily decreased after 2011, with variations by geographic region. There was no mortality and only 60 (2.6%) propranolol-related complications. African-American race (odds ratio (OR) 1.20 [95% CI: 1.02-1.41]), respiratory comorbidities (OR 2.04 [95% CI: 1.42-2.93]), neurologic conditions (OR 1.34 [95% CI: 1.09-1.59]), admission to an intensive care unit (OR 1.31 [95% CI: 1.09-1.59]), bronchospasm (OR 1.37 [95% CI: 1.22-1.55]), and hyperkalemia (OR 1.86 [95% CI: 1.08-3.20]) were associated with increased LOS. Neurologic conditions (OR 2.87 [95% CI: 1.76-4.67]) and respiratory comorbidities (OR 2.48 [CI: 1.43-4.30]) were associated with readmission. Average cost per admission was $5,158 ($3,259 to $8,560 range).
Conclusion:
There is an overall national decline in rate of admissions for IH propranolol therapy. Inpatient admission may be beneficial for patients with neurologic or respiratory conditions.
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