155 - Risk Factors for 90-Day Readmission and Prolonged Length of Stay after Hip Surgery in Children with Cerebral Palsy

Poster Number: 155
Publication Number: 155.305

Liam R. Butler, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Calista L. Dominy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Thomas M. Li, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Abigail Allen, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Sheena Ranade, Mount Sinai Health System, New York, NY, United States

Background: Children with cerebral palsy are commonly affected by hip dysplasia, and surgical intervention is generally necessary to improve functionality and quality of life. However, these procedures carry risk for various complications, long hospital stays, and readmissions. Much of the current literature documenting surgical outcomes consists of single institution studies with a wide range of follow up times and sample sizes.

Objective: This study utilizes a national database with in-patient and post-discharge data to generate a comprehensive understanding of specific risk factors that impact surgical complications and hospital course.

Design/Methods: The National Readmissions Database 2014-2018 was queried for pediatric patients with a cerebral palsy diagnosis. Patients who underwent hip reconstructive or salvage surgery were selected for analysis. Data on demographics, comorbidities, length of stay (LOS), readmissions, complication rates, and cost analysis were collected for the total cohort. Inferential statistics were used to analyze data.

Results: 1225 patients met the inclusion criteria. These patients had an average age of 9.3 ± 3.8 years old and were 42.8% female. 322 (26.3%) patients had a prolonged LOS of at least 5 days, and 174 (14.2%) patients required readmission within 90 days of surgery. The average costs incurred by treatment for LOS less than 5 days ($64542 ± $35475) more than doubled for stays of at least 5 days ($131758 ± $146057). Multiple factors were significant predictors for both elongated LOS and readmission including medical complications (LOS p< 0.01; Readmission p< 0.01), cardiac arrhythmias (LOS p< 0.01; Readmission p=0.04), and iron deficiency anemia (LOS p=0.02; Readmission p< 0.01). The full list of independent predictors is shown in Tables 1 and 2. The all-cause complication rate was 5.5%, and Medicaid status was a significant predictor of sustaining an inpatient medical complication (p < 0.01).Conclusion(s): It is understood that children with cerebral palsy commonly have comorbidities that influence hip procedure outcomes and course. We expand on this by establishing a national readmission rate (14.2%) and identifying specific comorbidities, such as cardiac arrhythmias and iron deficiency anemia, that put patients at a greater risk for readmission and/or elongated LOS. Patients covered by Medicaid are also more likely to sustain complications during care. This study demonstrates the importance of ensuring adequate access to care and identifying specific comorbidities to improve patient outcomes and quality of life, as well as ease the financial burden on their families.
Table 1. Independent Predictors of Extended Length of Stay (≥ 5 days)
Table 2. Independent Predictors of 90-Day Readmission