The National Landscape of Hospitalizations for Children With Medical Complexity

BACKGROUND: Children with medical complexity (CMC) are an evolving patient population at high risk of adverse health care outcomes while hospitalized. OBJECTIVE: Using a nationally representative cohort, we aimed to compare hospitalization resource use for CMC to non-CMC. METHODS: Using the 2022 Kids’ Inpatient Database, we identified CMC by the presence of at least 1 complex chronic condition (CCCs) and grouped CMC by 1, 2, or 3 or more CCC. The outcomes were length of stay, hospitalization costs, and in-hospital mortality across CMC groupings compared with non-CMC. RESULTS: Of 3 169 944 pediatric hospitalizations in the United States, 389 127 (12.3%), 118 257 (3.7%), and 155 196 (4.9%) had 1 CCC, 2 CCC, and 3 or more CCC, respectively. Relative to nonCMC, each CMC group had significantly higher odds of in-hospital mortality (1 CCC: adjusted odds ratio [aOR] 31.3 [29.0, 33.7], P <.001; 2 CCC: aOR 53.5 [49.1, 58.2], P <.001; 3+ CCC: aOR 66.9 [61.1, 73.4], P <.001), longer length of stay in days (1 CCC: +3.20, [2.95, 3.44], P <.001; 2 CCC: +6.50, [5.97, 7.02], P <.001; 3+ CCC: +11.6 [10.8, 12.4], P <.001), and higher hospitalization costs (1 CCC: +$13 388 [11 947, 14 829], P <.001; 2 CCC: +$29 426 [26 233, 32 619], P <.001; 3+ CCC: +$57 426 [51 272, 63 580], P <.001). CONCLUSIONS: We highlight substantial health services use and in-hospital mortality for CMC compared with non-CMC. Health systems can use our findings to analyze cost-effectiveness of targeted interventions for CMC, as well as advocate for policy-based changes to reduce hospitaland individual-level inequities for CMC.