Hospital Care for Children With Neuromuscular Spine Disease in the United States

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STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: We analyzed inpatient health care utilization, costs, and outcomes for pediatric neuromuscular scoliosis (NMS) in the US from 2003 to 2019. We describe hospitalization characteristics and identify predictors of perioperative complications. SUMMARY OF BACKGROUND DATA: The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) collects nationally representative weighted data samples of pediatric hospital discharges. METHODS: We identified hospitalizations related to spinal fusion procedures for NMS in children from 2003, 2006, 2009, 2012, 2016, and 2019. Hospitalizations were categorized as surgical (initial spinal fusion, wound dehiscence, wound infection) and complication-related (pneumonia, urinary tract infection, paralytic ileus, respiratory failure). Weighted national estimates of admissions, inflation-adjusted charges (2019 USD), length of stay (LOS), and hospital days were calculated. Survey-weighted logistic regression identified independent predictors of perioperative complications. RESULTS: Admissions for NMS rose >30-fold from 235 in 2006 to 7242 in 2019. Total charges increased from $22 million to $1.31 billion, and the mean charge per hospitalization increased from $99,700 to $182,100. Hospital days increased from 1942 to 58,528, and median LOS remained consistent at 8 days. In 2019, NMS accounted for 0.1% of pediatric admissions, 0.25% of hospital days, and 0.6% of hospital charges in the United States. Surgical wound complications were <0.5% of encounters but incurred mean charges exceeding $456,000 and median LOS of 30 days. Among 15,821 weighted encounters, overall mortality was 0.7%. The likelihood of perioperative complications was higher among children transferred from another facility or covered by public or "other" insurance, whereas age older than or equal to 10 years and Black race were associated with lower odds of complications ( P <0.05). CONCLUSIONS: Over the past two decades, pediatric NMS has become substantially more resource-intensive, driven particularly by rising procedure costs, despite stable LOS and low mortality. Strategies for reducing perioperative complications may mitigate the economic burden of this vulnerable population. LEVEL OF EVIDENCE: Level IV.

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