Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database

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ABSTRACT

Background

With scientific and technological advances in intensive care, there is an increasing survival rate among neonates with complex medical problems who experience an extremely prolonged length of stay (EPLOS) of ≥180 days in the hospital. Little is known about the antecedents and characteristics of this particular group of neonates.

Aim

To characterize the risk factors associated with EPLOS in neonates.

Patients and methods

Retrospective study of neonates from the National Hospital Discharge Database for Children, Kids Inpatient Database 2012 (KIDS-2012), maintained by the Healthcare Cost and Utilization Project (HCUP), using data from 4,170 hospitals in 44 states in the US. All neonates with complicated births who were discharged from the hospital other than from the normal newborn nursey during the year 2012 were included. Newborns with uncomplicated hospital stays who were discharged from the normal newborn nursery were excluded. Diagnoses and procedures were retrieved using ICD-9 codes. Descriptive analyses were done to identify incidence and prevalence. Comparisons were made of neonates with EPLOS (LOS ≥180 days) and non-EPLOS (LOS ≤179 days) using univariate and multivariate analyses.

Results

A total of 1,314,066 neonates with complicated births discharged from US hospitals in 2012 were included in the analysis. The incidence of EPLOS was 6.2/10,000 ( n = 812). On univariate analyses, neonates with EPLOS were more likely to have the following risk factors: Black race, Medicaid insurance, ZIP codes associated with lower median incomes, and born in the South and Midwest regions of the US. Most were neonates who had a surgical procedure done, especially tracheostomy and gastrostomy, being the most common procedures.

Conclusion

The occurrence of EPLOS is relatively uncommon among hospitalized neonates. The clinical and demographic characteristics of this subset of complicated neonates are distinct and can be anticipated using prediction models. Prediction models for EPLOS may be important for public policy issues and the proper allocation of healthcare resources.

How to cite this article

Totapally BR, Hussain N, Raju VN. Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database. Newborn 2023;2(3):179–184.

Related collections

Most cited references 16

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Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.

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Long-stay patients in the pediatric intensive care unit.

A Slonim, U Ruttimann, Keshia Pollack … (2001)

Length of stay in the pediatric intensive care unit (PICU) is a reflection of patient severity of illness and health status, as well as PICU quality and performance. We determined the clinical profiles and relative resource use of long-stay patients (LSPs) and developed a prediction model to identify LSPs for early quality and cost saving interventions. Nonconcurrent cohort study. A total of 16 randomly selected PICUs and 16 volunteer PICUs. A total of 11,165 consecutive admissions to the 32 PICUs. None. LSPs were defined as patients having a length of stay greater than the 95th percentile (>12 days). Logistic regression analysis was used to determine which clinical characteristics, available within the first 24 hrs after admission, were associated with LSPs and to create a predictive algorithm. Overall, LSPs were 4.7% of the population but represented 36.1% of the days of care. Multivariate analysis indicated that the following factors are predictive of long stays: age <12 months, previous ICU admission, emergency admission, no CPR before admission, admission from another ICU or intermediate care unit, chronic care requirements (total parenteral nutrition and tracheostomy), specific diagnoses including acquired cardiac disease, pneumonia, and other respiratory disorders, having never been discharged from the hospital, need for ventilatory support or an intracranial catheter, and a Pediatric Risk of Mortality III score between 10 and 33. The performance of the prediction algorithm in both the training and validation samples for identifying LSPs was good for both discrimination (area under the receiver operating characteristics curve of 0.83 and 0.85, respectively), and calibration (goodness of fit, p = .33 and p = .16, respectively). LSPs comprised from 2.1% to 8.1% of individual ICU patients and occupied from 15.2% to 57.8% of individual ICU bed days. LSPs have less favorable outcomes and use more resources than non-LSPs. The clinical profile of LSPs includes those who are younger and those that require chronic care devices. A predictive algorithm could help identify patients at high risk of prolonged stays appropriate for specific interventions.

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Effect of sex and race on outcome in patients undergoing congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database.

Daniel J DiBardino, Sara Pasquali, Jennifer Hirsch … (2012)

Previous studies on the impact of race and sex on outcome in children undergoing cardiac operations were based on analyses of administrative claims data. This study uses clinical registry data to examine potential associations of sex and race with outcomes in congenital cardiac operations, including in-hospital mortality, postoperative length of stay (LOS), and complications. The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) was queried for patients younger than 18 years undergoing cardiac operations from 2007 to 2009. Preoperative, operative, and outcome data were collected on 20,399 patients from 49 centers. In multivariable analysis, the association of race and sex with outcome was examined, adjusting for patient characteristics, operative risk (Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery [STAT] mortality category), and operating center. Median age at operation was 0.4 years (interquartile range 0.1-3.4 years), and 54.4% of patients were boys. Race/ethnicity included 54.9% white, 17.1% black, 16.4% Hispanic, and 11.7% "other." In adjusted analysis, black patients had significantly higher in-hospital mortality (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.37-2.04; p<0.001) and complication rate (OR, 1.15; 95% CI, 1.04-1.26; p<0.01) in comparison with white patients. There was no significant difference in mortality or complications by sex. Girls had a shorter LOS than boys (-0.8 days; p<0.001), whereas black (+2.4 days; p<0.001) and Hispanic patients (0.9 days; p<0.01) had longer a LOS compared with white patients. These data suggest that black children have higher mortality, a longer LOS, and an increased complication rate. Girls had outcomes similar to those of boys but with a shorter LOS of almost a day. Further study of potential causes underlying these race and sex differences is warranted. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (publisher-id): JNB

Title: Newborn

Abbreviated Title: JNB

Publisher: Jaypee Brothers Medical Publishers

ISSN (Electronic): 2769-514X

Publication date (Print): July-September 2023

Volume: 2

Issue: 3

Pages: 179-184

Affiliations

[1 ]Division of Critical Care Medicine, Nicklaus Children's Hospital; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America

[2 ]Division of Neonatology, Connecticut Children's Medical Center, Hartford; UCONN School of Medicine, Farmington, Connecticut, United States of America

[3 ]Division of Neonatology, Baylor Scott and White Hospital, Temple, Texas, United States of America

Author notes

Balagangadhar R Totapally, Division of Critical Care Medicine, Nicklaus Children's Hospital; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America. Phone: +305 662 2639, e-mail: balagangadhar.totapally@ 123456nicklaushealth.org

Article

DOI: 10.5005/jp-journals-11002-0067

SO-VID: 77bea2aa-1d19-4ac2-ab4c-3cd1cd5ff8ea

License:

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 05 July 2023

Date accepted : 10 August 2023

Date: 25 September 2023

Custom metadata

file-pdf jnb-02-179.pdf

ScienceOpen disciplines: Pediatrics

Keywords: Pediatric Intensive Care Unit,Neonatal Intensive Care Unit,Hospital Length of Stay

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: Pediatric Intensive Care Unit, Neonatal Intensive Care Unit, Hospital Length of Stay

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