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J Hosp Med. 2019 Aug;14(8):474-481. doi: 10.12788/jhm.3222.

Discharge Medical Complexity, Change in Medical Complexity and Pediatric 30-day Readmission.

Author information

Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
University of Cincinnati College of Medicine, Cincinnati, Ohio.
James M. Anderson Center for Healthcare Improvement, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.
Department of Pathology, University of Chicago Medicine, Chicago, Illinois.
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Division of Academic General Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.
Departments of Pediatrics, Medicine, Medical Social Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.



While medical complexity is associated with pediatric readmission risk, less is known about how increases in medical complexity during hospitalization affect readmission risk.


We conducted a five-year retrospective, case-control study of pediatric hospitalizations at a tertiary care children's hospital. Cases with a 30-day unplanned readmission were matched to controls based on admission seasonality and distance from the hospital. Complexity variables included the number of medications prescribed at discharge, medical technology, and the need for home healthcare services. Change in medical complexity variables included new complex chronic conditions and new medical technology. We estimated odds of 30-day unplanned readmission using adjusted conditional logistic regression.


Of 41,422 eligible index hospitalizations, we included 595 case and 595 control hospitalizations. Complexity: Polypharmacy after discharge was common. In adjusted analyses, being discharged with ≥2 medications was associated with higher odds of readmission compared with being discharged without medication; children with ≥5 discharge medications had a greater than four-fold higher odds of readmission. Children assisted by technology had higher odds of readmission compared with children without technology assistance. Change in complexity: New diagnosis of a complex chronic condition (Adjusted Odds Ratio (AOR) = 1.75; 1.11-2.75) and new technology (AOR = 1.84; 1.09-3.10) were associated with higher risk of readmission when adjusting for patient characteristics. However, these associations were not statistically significant when adjusting for length of stay.


Polypharmacy and use of technology at discharge pose a substantial readmission risk for children. However, added technology and new complex chronic conditions do not increase risk when accounting for length of stay.

[Available on 2020-08-01]

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