48 - Predictors of Length of Stay and Total Admission Costs for Operative Reduction of Developmental Dysplasia of the Hip: A Nationwide Analysis from 2016-2022

Publication Number: 3045.48

Ryan G.. Smolarsky, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Laurel E. Wong, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Sheena Ranade, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: While developmental dysplasia of the hip (DDH) is increasingly being managed with early detection and nonoperative treatment, operative reduction is a common intervention indicated for patients with more severe or later presentations. Although some studies have investigated resource allocation regarding operative reduction for DDH, no studies have determined predictors of inpatient postoperative outcomes using both socioeconomic factors and hospital characteristics at the nationwide level.

Objective: To identify variables associated with longer length of stay or increased total cost of admission after operative reduction for DDH.

Design/Methods: The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was assessed for patients with DDH that underwent any operative hip reduction, excluding neuromuscular cases (cerebral palsy, spina bifida, Down syndrome). Patient and hospital characteristics were recorded and used to perform multivariable logistic regression to determine predictors of length of stay and increased total cost of admission, defined as the top quartile.

Results: From 2016-2022, 80.0% (1,434) of patients were female (age 4.5 ± 5.2 years) with cost of admission $66,739.22 ± $60,508.62 and length of stay 2.6 ± 5.9 days. Significant variables in regression for length of stay were age in years (OR = 1.19, 95% CI = 1.16-1.22, p < 0.01), Medicaid as primary payer (OR = 1.55, 95% CI = 1.10-2.18, p = 0.01), Midwest hospitals (OR = 0.38, 95% CI = 0.19-0.73, p < 0.01), urban non-teaching/rural hospitals (OR = 3.17, 95% CI = 1.32-7.63, p = 0.01), children's hospitals (OR = 0.06, 95% CI = 0.01-0.66, p = 0.02), and number of beds (OR = 1.57, 95% CI = 1.08-2.27, p = 0.02). Significant variables in regression for cost of admission were year of admission (OR = 1.15, 95% CI = 1.09-1.21, p < 0.01), age in years (OR = 1.14, 95% CI = 1.11-1.16, p < 0.01), Midwest hospitals (OR = 0.40, 95% CI = 0.22-0.75, p < 0.01), South hospitals (OR = 1.86, 95% CI = 1.12-3.09, p = 0.02), and West hospitals (OR = 2.17, 95% CI = 1.26-3.76, p < 0.01).

Conclusion(s): Age, region, primary payer, and hospital type were significant predictors of length of stay and total admission costs for patients with DDH after undergoing operative reduction. These findings exhibit disparities and regional variations in system-level outcomes that may inform future management of patients with DDH after operative reduction.

Characteristics of patients undergoing operative reduction for developmental dysplasia of the hip, 2016-2022.
Quartiles vary in range by year. For 2016, quartiles were (1) $1-42,999, (2) $43,000-53,999, (3) $54,000-70,999, (4) $71,000+. For 2019, quartiles were (1) $1-47,999, (2) $48,000-60,999, (3) $61,000-81,999, (4) $82,000+. For 2022, quartiles were (1) $1-55,999, (2) $56,000-70,999, (3) $71,000-93,999, (4) $94,000+.

Characteristics of hospitals performing operative reduction for developmental dysplasia of the hip, 2016-2022.
Number of beds varies depending on teaching status. Rural: small = 1-49, medium = 50-99, large = 100+. Urban non-teaching: small = 1-99, medium = 100-199, large = 200+. Urban teaching: small = 1-299, medium = 300-499, large = 500+.

Multivariable logistic regression model for longer length of stay and increased cost of admission after operative reduction for developmental dysplasia of the hip.
a = Significant at α = 0.05.
b = Relative to private insurance as primary payer.
c = Variable demonstrated complete separation and thus was dropped from final analysis.
d = Relative to 1st quartile median income ZIP code.
e = Relative to Northeast region.
f = Relative to urban teaching hospitals.