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A Study of Health Care Utilization and Comorbidities Associated With Congenital Anorectal Malformations in the United States
Karlo Kovacic*1, Sravan Matta1, Katja Kovacic1, Ke Yan2, Casey M. Calkins3, Manu R. Sood1
1Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI; 2Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI; 3Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI
Background: Multiple congenital anomalies are associated with anorectal malformations (ARMs) in children. Large population based studies regarding health care utilization and comorbidities associated with ARMs are lacking in the United States.
Aim: To study the prevalence of congenital anomalies and health care utilization in children with ARMs.
Method: We used Kids' Inpatient Database (KID) for the years 2006, 2009 and 2012 for data collection. ICD 9 codes (48.40, 48.41, 48.42, 48.43, 48.49, 751.2, and 751.5) were used to identify patients with ARMs.
Results: A total of 2396 children <2 years of age were identified using weighted analysis from the Kids' Inpatient Database, 57.3% of the subjects were male. The ethnic subgroups were 40.1% Caucasian, 9.3% African American, 23.6% Hispanic and 27% of patients belonged to other ethnic groups. Congenital anomalies other than ARM were reported in 65% of patients (Table 1). Urogenital anomalies were present in 38.8% and 8.6% of the patients had VACTERL association. A genetic disorder was identified in 14.1% of the subjects. Spinal anomalies were present in 6.3% and 1.3% had Hirschsprung's disease.
Open pull through resections was performed in 94% of the patients and remaining had laparoscopic surgery. The details of the mean length of stay and health care expenditure for the years 2006, 2009 and 2012 for open pull through resection are shown in Table 2. There was a significant increase in health care expenditure for the years 2009 and 2012 compared to 2006 (p<0.0001). The average annual health care expenditure for surgical correction of ARMs and associated anomalies for the three years was US .5 million. The reported mortality associated with ARMs surgery for the three years was 0.2%.
Conclusion: A majority of children with ARMs have one or more additional congenital anomaly. Although mortality associated with surgery for repair of ARMs is low, management of these complex congenital anomalies is associated with a significant health care expenditure. The cost of health care management for these disorders seems to have increased significantly since 2006. This information will be helpful in future health care resource allocation and planning for management of these complex congenital disorders.
Table 1
| | Vertebral
Anomalies | Tracheo Esophageal
Anomalies | Cardiac
Anomalies | Renal
Anomalies | Vertebral
Anomalies | 4.9% | 0.4% | 2.6% | 2.2% | Tracheo Esophageal
Anomalies | 0.4% | 2.9% | 1.1% | 0.9% | Cardiac
Anomalies | 2.6% | 1.1% | 21.3% | 5.5% | Renal
Anomalies | 2.2% | 0.9% | 5.5% | 14.9% |
Table 2 | Year | 2006 | 2009 | 2012 | | Mean length of stay (days) | 6.2 (95% CI: 5.12 - 7.35) | 7.6 (95% CI: 5.7 - 9.4) | 6.9 (95% CI: 5.8 - 8.1) | | Mean total charges per admission (US 0 | 36,290 (95% CI: 30,947 - 41,632) | 55,216 (95% CI: 44,221 - 67,243)* | 66,988 (95% CI: 55,762 - 79,658)* |
* p value < 0.0001 compared to 2006
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