Factors Associated with Length of Stay and Cost among Pediatric Hospitalizations with a Primary Ophthalmic Diagnosis

Purpose: To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. Methods: This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids’ Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75^th percentile (>4 days and $12,642, respectively). Results: An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p = .03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p < .001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p = .04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p = .04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p = .02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p = .02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p < .001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p < .001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p < .05 for all). Conclusions: Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care.