S. Selvarajah1, E. B. Schneider1, E. R. Hammond1, M. Arafeh1, H. N. Alshaikh1, N. Nagarajan1, F. Gani1, H. Alturki1, C. K. Zogg1, A. Najafian1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Hypertrophic pyloric stenosis (HPS) affects 1-3 per 1,000 live births in the United States and is classically managed with pyloromyotomy. It has been proposed that complications occur less frequently when pyloromyotomy is performed at specialized children’s hospitals (CH), supporting the potential need for regionalized care. However, the majority of infants with HPS who undergo pyloromyotomy are admitted emergently, making regionalization arduous. We sought to evaluate the association between hospital type and in-hospital complications and cost of care after emergent pyloromyotomy among infants in a nationwide sample.
Methods: The 2006 and 2009 Kids Inpatient Database was utilized to identify all infants (age ≤1 year) admitted emergently for HPS that underwent pyloromyotomy. Weighted descriptive analysis was performed comparing the occurrence of post-operative complications at CH, general hospitals with children’s units (GHCU) and general hospitals without children’s units (GHNCU). Post-operative complications included hematoma, hemorrhage, shock, seroma, wound infection, and wound dehiscence. Cost per admission was calculated by multiplying hospital-specific cost-to-charge ratios with patient charges. Gamma regression was performed to estimate adjusted average cost per admission (in 2009 USD$), controlling for patient and hospital characteristics, and length of stay (LOS).
Results:Of the 18,703 infants who met inclusion criteria, 36.7% (n=6,858) were operated on in CH, 34.7% (n=6,487) in GHCU, and 28.7% (n=5,358) in GHNCU. The majority of infants were male (83.0%) and had government insurance (62.9%). Infants managed at GHNCU (31.5%) were more likely to have dehydration or metabolic derangement compared with infants at CH (24.3%, P=0.011) and GHCU (26.0%, P=0.006). However, infants at CH were more likely to undergo surgery on the day of admission compared with infants at GHNCU and GHCU (42.1 vs. 27.9% and 27.2% respectively, P<0.001 both). There was no significant difference in the occurrence of post-operative complications, as well as LOS across hospital types (Table). However, cost of care was $1,951 and $2,177 greater at CH compared with GHCU and GHNCU respectively.
Conclusion:The cost of managing infants admitted emergently for pyloromyotomy is substantially greater at specialized children’s hospitals. Further research is necessary to determine whether regionalizing care for common pediatric emergency procedures, such as pyloromyotomy, is necessary and cost-effective.
