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Factors Affecting Length of Stay for Children Hospitalized After Pediatric Surgical Procedures
Jay G Berry1,2, Steven J Staffa3, Peter Hong1,2
1Complex Care Service, Division of General Pediatrics.
Insights
Predicting pediatric postoperative length of stay (LOS) is crucial. This study found that both the type of surgery and the number of chronic conditions significantly impact a child's recovery duration.
Area of Science:
- Pediatric Surgery
- Hospital Medicine
- Healthcare Management
Background:
- Understanding postoperative length of stay (LOS) is vital for effective hospital medicine and surgical co-management.
- Variations in LOS exist across different surgical procedures in children.
- Identifying risk factors for prolonged LOS is essential for resource allocation and patient care planning.
Purpose of the Study:
- To assess the variation in postoperative LOS for children undergoing elective surgical procedures.
- To identify risk factors, specifically the number of chronic conditions, associated with prolonged LOS.
- To provide data for hospital medicine clinicians to better estimate postoperative LOS.
Main Methods:
- Retrospective analysis of pediatric patients undergoing elective surgery from January 2018 to October 2021.
- Comparison of postoperative LOS across 347 surgical procedure types.
- Multivariable quantile regression used to analyze the association between the number of chronic conditions and LOS.
Main Results:
- The median LOS across all procedures was 2 days (IQR 1-4).
- Procedures with a median LOS of ≥5.0 days accounted for 15.0% of hospitalizations and 46.8% of bed days.
- Children with ≥4 chronic conditions had a significantly prolonged LOS, with those having ≥10 conditions staying a median of 4.0 days longer.
Conclusions:
- The type of elective surgery and the number of chronic conditions are key predictors of pediatric postoperative LOS.
- Hospital medicine clinicians can utilize this information to estimate recovery times more accurately.
- This data supports improved planning and management for pediatric surgical patients.
Background:
Understanding the postoperative length of stay (LOS) by surgical procedure is important for hospital medicine clinicians involved in surgical co-management. We assessed variation in postoperative LOS for children after elective surgical procedures and risk factors for prolonged LOS.
Methods:
This study is a retrospective analysis of pediatric patients undergoing elective surgical procedures between January 1, 2018 and October 1, 2021 with postoperative hospitalization for recovery at a freestanding children's hospital. The postoperative LOS (number of days) was compared across types of surgery and by the number of chronic conditions (assessed with the Agency for Healthcare Research and Quality Condition Indicator system) using multivariable quantile regression.
Results:
The median (interquartile range) LOS across all 347 types of surgical procedures combined was 2 (interquartile range 1-4). Surgical procedures (n = 85) with a median LOS between 3.0 and <5.0 days (eg, spinal fusion, Chiari decompression) accounted for 20.9% of all hospitalizations (N = 12 139) and 23.1% of all postoperative bed days. Procedures (n = 46) with a median LOS of ≥5.0 days (eg, femoral osteotomy, bladder reconstruction) accounted for 15.0% and 46.8% of all hospitalizations and bed days, respectively. After controlling for the type of procedure, having ≥4 (versus none) chronic conditions was significantly associated with experiencing a prolonged LOS (90th percentile: 5.2 days); patients with 4 to 6, versus no, chronic conditions stayed a median of 1.4 (95% confidence interval [CI] 0.7-2.2) days longer, those with 7 to 9 chronic conditions stayed a median of 1.9 (95% CI 1.0-2.7) days longer, and those with ≥10 chronic conditions stayed a median of 4.0 (95% CI 3.3-4.7) days longer.
Conclusions:
Hospital medicine clinicians can use the type of surgery in combination with the number of chronic conditions to estimate postoperative LOS after elective surgical procedures in children.
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