Rates of hospital readmission are commonly used as a measure of quality of care in hospitalized patients. In adults, a shorter index hospitalization length of stay (LOS) has been found to be associated with a higher risk of hospital readmission, though the same has not been shown in a pediatric population. The aim of this retrospective cohort study (n=956,507) was to explore the association between length of hospital stay and pediatric readmissions. This study used clinical and billing data from 49 children’s hospitals, representing 20% of all US discharges for children. Reasons for condition-specific admissions were determined using the All-Patient Refined Diagnosis Related Groups (APR-DRGs) classification scheme. Researchers found that only 6 APR-DRGs for the index hospitalization had higher readmission rates with shorter hospital LOS. Of these 6 APR-DRGs, asthma, cellulitis and other bacterial skin infections, and nephritis and nephrosis had decreased 15-day readmissions. Dorsal and lumbar spine fusion (for scoliosis), cellulitis and other bacterial skin infections, all normal newborns, and newborns with hyperbilirubinemia had decreased 30-day readmissions. In terms of healthcare resources, depending on the APR-DRG, an estimated additional 18 to 148 hospital bed-days would be required to prevent a single readmission, with accompanying costs ranging from $41,000 to $1.4 million (for dorsal and lumbar spinal fusion). This study therefore shows a lack of robust association between index hospitalization LOS and hospital readmission among children, with few diagnoses demonstrating an inverse association between LOS and readmission.
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