Abstract
Objective Infants admitted to the neonatal intensive care unit (NICU) are at increased likelihood
of hospital readmission when compared with non-NICU admitted infants, resulting in
appreciable financial and emotional burdens. Early readmission, days to weeks, following
NICU discharge, may be preventable. Population-based data identifying potentially
modifiable factors and spending associated with early readmission are lacking.
Study Design We conducted a secondary data analysis of privately insured infants in the IBM MarketScan
Research Database born from 2011 to 2017 in all 50 states and admitted to the NICU.
We examined demographic and clinical characteristics of early readmission within 7
days and between 8 and 30 days following NICU discharge and the payments of NICU and
readmission care. Data were analyzed using univariate and multivariable logistic regression.
Results Of the 86,741 NICU survivors analyzed, 3,131 infants (3.6%) were readmitted by 7
days and 2,128 infants (2.5%) between 8 and 30 days. Preterm infants had reduced odds
of readmission by 7 days compared with term infants. Infants transferred to a step-down
facility (vs. discharge home) and those with congenital anomalies had higher independent
odds of readmission by 7 and 8 to 30 days. A higher percentage of NICU infants within
the lowest quartile of initial NICU length of stay (LOS) were readmitted by 7 days
compared with NICU infants in the middle and highest LOS quartiles (64 vs. 36%, p < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380,
respectively.
Conclusion Being term, being transferred to a step-down facility, and having a congenital anomaly
were risk factors for early readmission. Shorter initial NICU LOS may be a contributing
factor to readmission by 7 days, especially among term infants. These findings identify
factors associated with readmission with the hope of preventing early readmission,
minimizing spending, and optimizing ideal timing of NICU discharge.
Key Points
-
Preterm infants were less likely than term infants to be readmitted within 7 days
after discharge.
-
Transferred infants had higher odds of readmission versus those who were discharged
home.
-
Payments for an average single NICU day were $1,000 less than for an average day of
readmission.
Keywords
NICU - readmission - spending - length of stay
