Factors affecting Length of Stay in Pediatric Orthopedic Surgical Patients

Background: Length of stay is calculated by the Center for Medicaid and Medicare services based on different patient variables. This study aims to identify and understand which factors affect hospital stays in pediatric orthopedic surgery patients to create strategies to reduce length of stay and refine length of stay predictions for these patients. Methods: We conducted a retrospective chart review of 288 pediatric orthopedic patients admitted to the hospital from January 2018 to December 2021. All 288 patients met inclusion criteria. Data were collected and analyzed. Results: Of the 288 patients included in the study, the average expected length of stay estimated by Medicare was 4.00 days leading to a significant average difference in LOS of 4.68 days (P < 0.001). 82.63% (n = 238) of patients exceeded their predicted LOS. In comparing specific variables between patients, there was a significant difference in the age of patients (10.86 vs 13.46 years old [ P < 0.001]), number of x-rays (3.18 vs 1.3 [ P = 0.003]), number of consults (2.47 vs 1.4 [ P = 0.003]), occupational therapy involvement (3.65 vs 1.67 days [ P = 0.005]), and use of a post-op Foley (P <0.001) or post-op PCA medication (P = 0.002). Conclusion: 82% of the patients in this study had a longer length of stay than predicted with an average difference of 4.68 days. Several factors were associated with a longer predicted LOS which can help guide patient care and treatment to reduce the length of stay.