D. M. Hook-Dufresne1, X. Yu3, V. Bandla2, E. Imseis2, S. D. Moore-Olufemi1 1The University Of Texas Health Science Center Houston,Pediatric Surgery,Houston, TX, USA 2The University Of Texas Health Science Center Houston,Pediatric Gastroenterology,Houston, TEXAS, USA 3Baylor College Of Medicine,Pediatric Epidemiology,Houston, TEXAS, USA
Introduction: Gastroschisis (GS) is a common, congenital abdominal wall defect that can cause significant morbidity associated with the development of intestinal dysfunction and feeding intolerance. The purpose of this study was to provide an update on the economic impact of pediatric patients diagnosed with gastroschisis on a national and state level.
Methods: The Healthcare Cost and Utilization Project (HCUP) database was queried from 2007 -2011 for the following data: number of discharges, length of stay (LOS), costs and charges for all national pediatric (age < 1) hospital stays and all national pediatric (age < 1) hospital stays with the procedure code 54.71, designating repair of GS. The same data was collected for the state of Texas. The variation of differences in mean outcome between GS and normal infants over the years was negligible, thus we calculated the overall effect of having GS on LOS, cost and charges by the weighted average of the differences, where the weight was the reciprocal of the variance of the mean for each year. This value is represented by the combined estimate of difference (CED) and its standard error (SE). We performed a one-sample z test to compare the state CED against the national population CED.
Results: Pediatric patients under the age of 1 represent, on average, 11.86% of all national discharges. Pediatric patients with GS represent only 0.04% of all national pediatric discharges. Nationally, infants with GS had a significantly longer LOS (CED 38.5±0.9 days, p <0.0001). Infants with GS had significantly increased costs (CED $79,733±2,119, p <0.0001) and significantly increased charges (CED $249,999±9,652, p< 0.0001) for the national data. Data for the state of Texas reflected that of the national data. LOS was significantly longer for GS infants in the state of Texas (CED 41.6±2.5 days, p < 0.001). Texas infants with GS had significantly higher costs (CED $79,431±6,056, p <0.0001) and significantly higher charges (CED $252,611±27,752, p < 0.0001) when compared to non-GS infants. There were no significant differences between the state of Texas and the nation for LOS (p-value 0.22), costs (p-value 0.96), or charges (p-value 0.92).
Conclusion: While infants with GS represent a very small minority of both the national and Texas pediatric discharges, their LOS and costs greatly exceed their non-GS counterparts. Our findings reflect those of studies conducted more than 10 years ago, but interestingly, even when adjusting for the rate of inflation, the costs of caring for infants with GS continues to rise despite improved treatment strategies. Further investigation into the factors that promote the development of intestinal dysfunction and feeding intolerance in these patients is needed to significantly impact the economic burden of GS.