Hospitalizations by Children With Medical Complexity From 2009 to 2022

Children with medical complexity (CMC) have multifaceted health care needs and are more likely to be hospitalized than children without medical complexity. This study examined the number and proportion of hospitalizations experienced by CMC in the United States from 2009 to 2022 and describes hospitalization characteristics.

This retrospective repeated cross-sectional study analyzed the Kids' Inpatient Database in 2009, 2012, 2016, 2019, and 2022. CMC were identified using the Complex Chronic Condition Classification System and Pediatric Medical Complexity Algorithm. Survey weights were applied to generate national estimates of the number and proportion of nonbirth hospitalizations in children aged less than 18 years experienced by CMC each year, as well as the number and proportion of hospital days, in-hospital deaths, and costs incurred by CMC overall and at freestanding children's hospitals and general hospitals.

CMC experienced an estimated 1.14 million hospitalizations in 2009 and 1.02 million in 2022. In 2022, 37.8% (n = 386 961) of CMC-associated hospitalizations were at freestanding children's hospitals, and 62.2% (n = 636 789) were at general hospitals. These hospitalizations represented 49.0% (95% CI, 47.8%-50.3%) of pediatric hospitalizations in 2009 and 62.8% (95% CI, 61.7%-64.0%) in 2022. In 2022, CMC-associated hospitalizations accounted for 79.2% (95% CI, 76.8%-81.5%) of hospital days (n = 7.36 million days), 92.6% (95% CI, 91.7%-93.5%) of deaths (n = 9107), and 83.8% (95% CI, 81.3%-86.3%) of costs (30.6 billion US dollars) incurred by hospitalized children.

The estimated number of CMC-associated hospitalizations decreased modestly from 2009 to 2022. However, CMC accounted for increasing proportions of hospitalizations, hospital days, in-hospital deaths, and costs, justifying programs and policies to support their complex health care needs.