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 non-CMC, 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 hospital- and individual-level inequities for CMC.