Quick Take: Association of extending hospital length of stay with reduced pediatric hospital readmissions

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.

Click to read the study in JAMA Pediatrics

Image: PD

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