Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions

Abstract

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 30day 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%

Research priorities for children with neurological impairment and medical complexity in high‐income countries

“… 6 Multisystem involvement and multiple comorbidities from a characteristic pattern of co‐occurring conditions are common, requiring an increased complexity of care. 7 , 8 , 9 , 10 , 11 …”

Barriers to Discharge After Hip Reconstruction Surgery in Non-ambulatory Children With Neurological Complex Chronic Conditions

“…3 Neuromuscular hip dysplasia is common in nonambulatory children with neurological CCC and is often treated with surgical hip reconstruction. 8,9 Orthopaedic surgeries to treat children with neurologic CCC are high-cost procedures associated with increased complication rates, lengthy recovery times, and frequent hospital readmissions. 7,[10][11][12] Orthopaedic surgeries for musculoskeletal disease have been identified as the most common surgical cause of hospitalization for patients with neurologic CCC of all Gross Motor Function Classification System (GMFCS) levels with orthopaedic procedures involving the hip, lower extremity, or spine among the most frequent surgeries performed.…”

“…Children with neurologic CCC encompass static, progressive, central and peripheral neurological diseases, including, but not limited to cerebral palsy (CP), leukodystrophy, congenital brain malformations, muscular dystrophy, and spinal muscular atrophy 3. Neuromuscular hip dysplasia is common in nonambulatory children with neurological CCC and is often treated with surgical hip reconstruction 8,9. Orthopaedic surgeries to treat children with neurologic CCC are high-cost procedures associated with increased complication rates, lengthy recovery times, and frequent hospital readmissions 7,10–12.…”

Surgery for children with disabilities: not without risk

“…There are two new reports on the surgical care of children with disabilities, using big data from administrative databases in Taiwan and the United States. 1,2 In the study by Huang et al, children with intellectual disabilities were found to have approximately double the odds of postoperative pneumonia, sepsis, and mortality. 1 Interestingly, the odds of adverse events were increased in both tertiary and non-tertiary settings.…”

“…The risk of complications in children with disabilities increases with additional medical complexity. Berry et al used administrative data from 49 children’s hospitals in the United States to better understand the use of inpatient resources in children with neurological complex chronic conditions who underwent reconstructive hip surgery 2 . They showed that as the number of co‐existing conditions increased from one to four or more, length of stay increased by 67%, costs by 41%, and readmissions by 240%.…”