K. M. Herremans1, A. Yohann1, J. A. Taylor1, S. D. Larson1, D. Solomon1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Purpose: Hypertrophic pyloric stenosis (HPS) is a common condition in children with a 1:500 incidence. Patients typically present with forceful, repetitive emesis which leads to dehydration and failure to thrive. Delay in presentation is associated with a longer pre operative resuscitation and potentially longer hospital length of stay. The purpose of this study was to investigate the relationship between insurance and economic status with a delay in presentation for HPS.
Methods: A retrospective review of patients presenting with HPS was performed over a 5 year period. Patients who did not have the main procedure performed at our institution were excluded. Data regarding demographics, clinical history, time to presentation, and hospital course were collected. Insurance status was assessed, and patients without that information were excluded from final analysis. Zip code related census data was used as a proxy for economic status. The cohort was then divided by time to presentation and severity of hypochloremia. Students t test, Fisher’s exact test, and the Mann Whitney U test were used for comparative analysis.
Results: 167 patients were found, of which 155 met inclusion criteria. Overall, 84% patients had Medicaid. The cohort was divided into symptom duration less than or greater than 10 days, as well as by insurance status, and initial chloride level greater than or less than 95. There was no difference in racial or gender distribution among the groups, and the income data was not significantly different either. Commercial insurance patients had a shorter duration of symptoms than Medicaid cases (5.4 vs. 11.2 days), had higher chloride levels (99.4 vs. 91.5), were significantly younger (32.3 vs. 40.9 days), and spent half a day less in the hospital 3.27 vs. 3.85 days).
Conclusions: Patients with commercial insurance were significantly more likely to present earlier in the course, have a younger age, as well as a higher chloride level. In addition, patients with Medicaid tended to have more weight loss at presentation and stayed in the hospital longer. Despite the inability of census based income data to show any significance, these data would suggest that access to care may play an important role in timeliness of care for HPS.
