199 - Inpatient Charges and Readmission Analysis of Premature-Born Children with Developmental Dysplasia of the Hip: A Nationwide Database Study

Poster Number: 199
Publication Number: 199.143

Calista L. Dominy, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Liam R. Butler, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Renee Ren, 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: Risk factors for developmental dysplasia of the hip (DDH) in newborns include multiple gestation, positive family history, and breech position. Another factor discussed in recent literature both as a potential protective and risk factor is premature birth.

Objective: The objective of this study is to find characteristics significantly associated with premature-born pediatric DDH patients.

Design/Methods: The 2016-2018 National Readmissions Database (NRD) was used to find pediatric patients with a DDH diagnosis using International Classification of Diseases, 10th revision (ICD-10) codes. Patients were further stratified on premature birth. A propensity score matched cohort of non-DDH premature patients was also collected to control for confounding variables associated with prematurity alone. Demographic, comorbidity, and inpatient-related data were collected. Univariate analysis was performed to determine factors significantly associated with premature DDH status.

Results: 5227 patients were identified; 638 (12.2%) were born prematurely, and 4589 (87.8%) were full term. Less premature DDH patients were female (63.5% vs. 71.4%, p < 0.001). There was a significant difference in distribution of insurance coverage (p < 0.05) — premature DDH patients saw significantly lower percentages of private insurance (47.7% vs. 53.0%; p=0.013) and significantly higher percentages of Medicaid (45.8% vs. 40.5%; p=0.012) than the non-premature DDH group. Premature DDH patients had significantly higher total charges than non-premature DDH patients (p < 0.001). After comparing propensity score matched cohorts of premature DDH patients with premature non-DDH patients, premature DDH patients still had significantly higher charges (p < 0.001). Premature DDH patients had a significantly higher all-cause complication rate (p < 0.001) and 90-day readmission rate (8.3% vs. 5.0%, p < 0.001) than non-premature DDH patients.Conclusion(s): This study is the first to utilize a national database to identify a cohort of pediatric DDH patients. We evaluated demographic and inpatient factors between the premature and non-premature DDH patients and found significantly greater charges and longer lengths of stay for premature DDH patients, even after adjusting for confounding factors. We also found significantly greater complication rates and 90-day readmission rates in premature DDH patients. Thus, it is important to recognize premature birth in DDH patients as a potential risk factor for an increased cost burden and possibly more complex hospital stays and integrate that knowledge into a comprehensive care plan for this patient population.
Univariate analysis comparing various factors and their association to premature DDH patients and non-premature DDH patients.