Neighborhood deprivation is associated with longer hospital stay for common pediatric surgical procedures independent of complication rates.

BACKGROUND

Neighborhood deprivation begets care delays and complications after children's surgery in single center studies. We aimed to better understand these associations through generalizable data.

METHODS

We identified children undergoing six common operations using State Inpatient Databases, defining neighborhood deprivation using Child Opportunity Index. Risk-adjusted length of stay (LOS) and complication rates were compared using multivariable regression.

RESULTS

Among 102,399 children, neighborhood deprivation was associated with race, public insurance, and transfer. On risk-adjusted analysis, children with greater neighborhood deprivation had longer LOS for appendectomy (4.36 vs 4.21 days), skin graft (10.80 vs 8.55 days), and skin excision/debridement (10.45 vs 9.51 days). Risk-adjusted complication rates were not different, and LOS differences persisted in children without complications.

CONCLUSIONS

Children from deprived neighborhoods stay longer post-operatively, despite similar complication rates. Factors beyond clinical care are thus associated with utilization, and should inform how payment models and quality metrics account for these non-clinical factors.