L. V. Veras2, J. Smith2, A. Gosain2 2Univeristy Of Tennessee Health Science Center,Pediatric Surgery,Memphis, TN, USA
Introduction:
Patients with anorectal malformations (ARM) are at risk for associated anomalies (VACTERL: vertebral, anorectal, cardiac, tracheal, esophageal, renal, limb) and should undergo several screening exams in the first year of life. We hypothesized that racial and socioeconomic disparities exist in the screening processes for these patients.
Methods:
Following IRB approval, a retrospective review of patients with anorectal malformation born between 2005 and 2016 was performed at an urban, quaternary care children’s hospital. Demographics including gender, race, insurance, and zip code were collected. Zip code was used as a surrogate for median income. Chart review was performed to identify anomaly type and whether chest x-ray, skeletal survey, “babygram”, spine and renal ultrasounds, echocardiogram, and spine MRI were performed within one year of age. Descriptive statistics and Chi square analysis were performed.
Results:
101 patients (59.4% male, 79% low malformation) were identified. Black and white subjects each represented 41% of the population, and 69% of subjects had government insurance. Mean number of studies per patient was 5 +/- 1.7. There was no difference in median number of studies when comparing by race, insurance, or income group. Patients with high anomalies received a greater number of studies (p= 0.0153). None of the studies were found to be completed in 100% of the patients during the study period (Table 1). However, of the studies that were done, 100% of chest x-rays, skeletal surveys, babygrams, and spine ultrasounds were performed within one year of life. 98.9% of renal ultrasounds and 97.8% of echocardiograms were performed within one year. Spine MRI had the lowest rate of completion. Of those studies that were completed within one year, the most common to show abnormal results were echocardiograms (90%), spine ultrasounds (40.3%), and skeletal surveys (38.9%). There were no differences in the proportion of completed studies when comparing race, insurance, or income group, with the exception of skeletal surveys. More African-American patients received a skeletal survey (80.5%) than Caucasians (58.5%, p=0.0429). With respect to the time from birth to completion of a study, there were some significant differences noted when comparing insurance types and income groups, however no pattern of systematic bias was identified. For patients with abnormal study results, there were no differences in time to study completion by race or income; however, subjects with government insurance and abnormal spine ultrasounds had a longer median time to ultrasound than subjects with other insurance types (p=0.0140).
Conclusion:
There do not appear to be racial or socioeconomic disparities in screening for VACTERL anomalies in patients with ARM. However, overall gaps in screening still exist, and work must be done to appropriately screen all patients for associated anomalies.
