Associations Between Obesity and Use for Pediatric Hospitalizations

Hosp Pediatr. 2020 Nov;10(11):997-1001. doi: 10.1542/hpeds.2020-0136.


Background: Obesity is associated with poor outcomes for specific clinical groups of hospitalized children, but few data exist on outcomes of children with obesity on a larger scale during hospitalization. Therefore, we aimed to determine if use outcomes differ between hospitalized children with obesity and hospitalized children without obesity.

Methods: We performed a retrospective longitudinal cohort study of all children aged 2 to 19 years hospitalized at a single academic institution between January 1, 2009, and December 31, 2016. BMI was calculated from documented height and weight; obesity was defined by using age- and sex-specific BMI percentile guidelines from the Centers for Disease Control and Prevention. Only All Patient Refined Diagnosis-Related Groups (APR-DRGs) with >100 admissions during the study period were included. Primary outcome measures included hospital length of stay, hospital cost, and 14-day readmission. Generalized linear and logistic models were used to determine adjusted differences for outcome measures between patients with and without obesity.

Results: Of 78 756 included hospitalizations, obesity rates increased from 16.5% in 2009-2010 to 17.3% in 2015-2016 (P = .002). Only 6 (4.7%) of the 128 APR-DRGs examined were associated with increased use for patients with obesity: spinal procedures, tonsil and adenoid procedures, major respiratory procedures, peptic ulcer and gastritis, other musculoskeletal diagnoses, and other kidney and urinary tract diagnoses. There were no APR-DRGs with increased length of stay for children with obesity.

Conclusions: Obesity is associated with increased hospitalization cost and readmission rates for a minority of diagnosis groups. Some groups of hospitalized children with obesity may benefit from targeted interventions to reduce obesity-specific risks. Future research should be focused on disparities in other relevant clinical outcomes.

MeSH terms

  • Child
  • Female
  • Hospital Costs*
  • Hospitalization*
  • Humans
  • Length of Stay
  • Longitudinal Studies
  • Male
  • Obesity / epidemiology
  • Retrospective Studies