887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States

Abstract

Abstract Background Changes in management of bone infections, particularly early transition to oral antibiotic therapy, have decreased length of stay (LOS) for children hospitalized with acute osteomyelitis. However, evaluation of differences in length of stay by race and ethnicity have been limited. Methods Using the Kids’ Inpatient Database, we conducted a cross-sectional study of children ages 0–20 years hospitalized in 2016 or 2019 with a primary or secondary diagnosis of acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled length of study (LOS) by race and ethnicity, accounting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included predictors of LOS > 7 days (equivalent to LOS in the highest quartile), central venous catheter (CVC) placement, and time to debridement. Results We identified 2,388 patients discharged with acute osteomyelitis. Median LOS was 5 days (IQR 3–7). Black race (adjusted incidence rate ratio [aIRR] 1.15, 95%CI 1.05–1.27), Hispanic ethnicity (aIRR 1.11, 95% CI 1.02–1.21), and other race and ethnicity (aIRR 1.12, 95% CI 1.01–1.23) were associated with longer LOS, compared to White race (Figure 1). Additional factors associated with prolonged LOS were Medicaid/self-pay status (aIRR 1.14, 95% CI 1.07–1.21) and other insurance (aIRR 1.21, 95% CI 1.02–1.45), compared to private insurance; debridement procedure (aIRR 1.31, 95%CI 1.23–1.31); CVC placement (aIRR 1.41, 95% CI 1.31–1.51), and complex chronic condition (aIRR 1.21, 95% CI 1.11–1.33). The odds of Black children experiencing LOS > 7 days was 46% higher compared to White children (aOR 1.46, 95% CI 1.01–2.11; Figure 2). There were no differences by race and ethnicity on odds of CVC placement or time to debridement. Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile. Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile. Conclusion Black, Hispanic, and other race and ethnicity children with acute osteomyelitis experienced longer LOS than White children. Further research into mechanisms underlying these differences, including social determinants such as access to care or structural racism, may be important to improve care for children with osteomyelitis. Disclosures All Authors: No reported disclosures.