Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions

Dev Med Child Neurol. 2021 Feb;63(2):204-210. doi: 10.1111/dmcn.14712. Epub 2020 Nov 9.


Aim: To assess how co-occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs).

Method: This was a retrospective analysis of 4058 children age 4 years or older with neurological CCCs who underwent hip reconstructive surgery between 1st January 2015 and 31st December 2018 in 49 children's hospitals. The presence of co-occurring chronic conditions was assessed using the Agency for Healthcare Research Chronic Condition Indicator system. Multivariable, hierarchical regression was used to assess the relationship between co-existing conditions and postoperative hospital length of stay (LOS), cost, and 30-day readmission rate.

Results: The most common co-occurring conditions were digestive (60.1%) and respiratory (37.9%). As the number of co-existing conditions increased from one to four or more, median LOS increased 67% (3d [interquartile range {IQR} 2-4d] to 5d [IQR 3-8d]); median hospital cost increased 41% ($20 248 [IQR $14 921-$27 842] to $28 692 [IQR $19 236-$45 887]); and readmission rates increased 250% (5.5-13.9%), p<0.001 for all. Of all specific co-existing chronic conditions, malnutrition was associated with the greatest increase in postoperative hospital resource use.

Interpretation: Co-occurring conditions, and malnutrition in particular, are a significant risk factor for prolonged, in-hospital recovery after hip reconstruction surgery in children with a neurological CCC. Further investigation is necessary to assess how improved preoperative optimization of multiple co-occurring conditions may improve postoperative outcomes and resource utilization.

What this paper adds: Children with neurological complex chronic conditions (CCCs) often develop hip disorders which require hip reconstruction surgery. Co-occurring conditions are common in children with neuromuscular CCCs. Having four or more chronic conditions was associated with a longer length of stay, increased costs, and higher odds of readmission. Malnutrition was a significant risk factor for prolonged hospitalization after hip reconstruction surgery.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Arthroplasty / economics*
  • Arthroplasty / statistics & numerical data
  • Child
  • Child, Preschool
  • Chronic Disease
  • Comorbidity
  • Digestive System Diseases / epidemiology
  • Female
  • Hip / surgery*
  • Humans
  • Joint Diseases / epidemiology
  • Joint Diseases / etiology*
  • Joint Diseases / surgery*
  • Length of Stay / economics*
  • Length of Stay / statistics & numerical data
  • Male
  • Malnutrition / epidemiology
  • Nervous System Diseases / complications*
  • Nervous System Diseases / economics*
  • Nervous System Diseases / epidemiology
  • Outcome Assessment, Health Care
  • Patient Readmission / economics*
  • Patient Readmission / statistics & numerical data
  • Respiration Disorders / epidemiology
  • Retrospective Studies
  • Young Adult