Neonatal inpatient stays longer than one year: Who was admitted, what happened, and how much did it cost?

Abstract

Background: Anecdotal evidence suggests that some preterm infants remain hospitalized for more than a year, but little is known about this population. We aimed to describe the characteristics, the hospital course, and the hospital costs for preterm hospitalizations with length of stay (LOS) ≥365 days.

Methods: This was a retrospective, descriptive cohort study of the 2016 and 2019 Kids Inpatient Database. ICD-10 codes were used to identify preterm infants, their comorbidities, and surgical interventions. The study population was dichotomized into LOS ≤364 days (PT364) and LOS ≥365 days (PT365) and compared using Chi-square or Mann-Whitney U test as appropriate. The exposure was PT365, and the outcomes were the characteristics, comorbidities, discharge disposition, and inflation-adjusted hospital costs.

Results: Among 688,995 preterm infants, 111 had LOS ≥365 days (0.016%). Compared to PT364, PT365 were more likely to be males (74.6% vs 53.2%), of gestational age ≤27 weeks (71.5% vs 4.7%), and <1000 gm birthweight (64.2% vs 4.0%). PT365 were more likely to have a higher prevalence of comorbidities in each organ system, surgical and procedural interventions, and neonatal chronic complex conditions (872% vs 13.3%). PT365 were less likely to be discharged home (45.7% vs 93.4%) and more likely to be discharged to home healthcare (28.0% vs 5.7%) or to a skilled nursing facility (16.0% vs 0.8). The median hospital cost per surviving PT365 was $1,616,336.

Conclusion: PT365 was rare but was associated with complex chronic conditions, increased morbidity and surgical burden, and high inflation-adjusted hospital costs.