Abstract
Purpose: Although the incidence of myelomeningocele (MMC) has declined over the past decades with folic acid supplementation and prenatal screening, neural tube defects remain the most common birth defect in the USA. A majority of affected neonates require surgical repair. To characterize US trends in the epidemiology and hospital utilization of MMC repair over the past decade, we analyzed a nationally representative database. Methods: We queried the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Database (KID) for all discharges with procedure code for MMC repair for the years 2000, 2003, 2006, and 2009. The cohorts from these time points were compared for their demographic and in-hospital variables. Results are reported as estimated frequencies and means with 95 % confidence intervals (CI). Results: Sex, race, insurance status, family income level, and mortality of affected infants have not changed significantly over the decade. A majority of neonatal MMC repairs occur in larger hospital bed size and more specialized children’s hospital centers. Of patients, 52.3 to 60 % receive VPS placement during the same admission as the primary MMC repair. Total hospital costs for the MMC hospitalizations have remained relatively stable from 42,843 dollars in 2003 to 46,749 dollars in 2009 (adjusted to 2009 dollars). Conclusion: Demographics of children having MMC repair have not changed significantly over the past decade, while these surgeries have become more concentrated in pediatric-specialized centers. There appears to be a plateau in public health and access advances with relatively stable cost of MMC hospital care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1273-1279 |
| Number of pages | 7 |
| Journal | Child's Nervous System |
| Volume | 32 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2016 |
Funding
The Kid’s Inpatient Database (KID) was created by the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality. It contains a nationally representative sample of discharge-level data from pediatric hospitalizations from non-federal community hospitals in participating states. The database consists of records from 2 to 3 million pediatric discharges, weighted to represent 6.5–7.5 million national discharges. The number of participating states grew from 27 to 44 between 2000 and 2009 []. Sample weights are provided using the American Hospital Association (AHA) universe of non-federal community hospitals as the standard. Hospital data are stratified by the following six characteristics: ownership/control, bed size, teaching status, rural/urban location, US region, and status as a freestanding children’s hospital []. Exempt status for database study as non-human subjects research was granted from our Institutional Review Board.
Keywords
- Epidemiology
- Myelomeningocele
- Neural tube defect
- Spina bifida
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Clinical Neurology