title: Mental Health Conditions and Medical and Surgical Hospital Utilization.
abstract: Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs.
  
  
  
  Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios.
  
  
  
  A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs.
  
  
  
  Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; doupniks@chop.edu.|The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Doupnik
authors.affiliation: Children's Hospital Association, Washington, District of Columbia.|Children's Hospital Association, Overland Park, Kansas.
authors.forename: John
authors.initials: J
authors.lastname: Lawlor
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.affiliation: Department of Pediatrics, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.affiliation: Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California; and.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Bardach
authors.affiliation: Children's Hospital Association, Washington, District of Columbia.|Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D013502:General Surgery; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000191:economics*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D009426:Netherlands; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult