title: Children's hospitals with shorter lengths of stay do not have higher readmission rates.
abstract: OBJECTIVE
  To test the hypothesis that children's hospitals with shorter length of stay (LOS) for hospitalized patients have higher all-cause readmission rates.
  
  
  METHODS
  Longitudinal, retrospective cohort study of the Pediatric Health Information System of 183616 admissions within 43 US children's hospitals for appendectomy, asthma, gastroenteritis, and seizure between July 2009 and June 2011. Admissions were stratified by medical complexity, based on whether patients had a complex chronic health condition, were neurologically impaired, or were assisted with medical technology. Outcome measures include LOS; all-cause readmission rates within 3, 7, 15, and 30 days; and the association between hospital-specific mean LOS and all-cause readmission rates as determined by linear regression.
  
  
  RESULTS
  Mean LOS was <3 days for all patients across all conditions, except for appendectomy in complex patients (mean LOS 3.7 days, 95% CI 3.47-4.01). Condition-specific 3-, 7-, 15-, and 30-day all-cause readmission rates for noncomplex patients were all <5%. Condition-specific readmission rates for complex patients ranged from <1% at 3 days for seizures to 16% at 30 days for gastroenteritis. There was no linear association between hospital-specific, condition-specific mean LOS, stratified by medical complexity, and all-cause readmission rates at any time interval within 30 days (all P values ≥.10).
  
  
  CONCLUSIONS
  In children's hospitals, LOS is short and readmission rates are low for asthma, appendectomy, gastroenteritis, and seizure admissions. In the conditions studied, there is no association between shorter hospital-specific LOS and higher readmission rates within the LOS observed.
authors.affiliation: Department of Pediatrics, Children's Medical Center, Dallas, TX. Electronic address: rustin.morse@childrens.com.
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.forename: Denise M
authors.initials: DM
authors.lastname: Goodman
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: James C
authors.initials: JC
authors.lastname: Gay
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.forename: Gary
authors.initials: G
authors.lastname: Frank
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hain
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000601:surgery; D001249:Asthma / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D005759:Gastroenteritis / Q000628:therapy; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012640:Seizures / Q000628:therapy
keywords: APR-DRG; All Patient Refined Diagnostic Related Group; LOS; Length of stay