The Impact of Insurance, Race, and Ethnicity on Age at Surgical Intervention among Children with Nonsyndromic Craniosynostosis

Lin, Yimo; Pan, I‐Wen; Harris, Dominic A.; Luerssen, Thomas G.; Lam, Sandi

doi:10.1016/j.jpeds.2015.02.007

Cited by 52 publications

(60 citation statements)

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“…Algorithms in the published literature and the recommendations of the US Food and Drug Administration's MiniSentinel program for identifying health outcomes of interest from administrative and claims data were used (http:// www.mini-sentinel.org/methods/outcome_identification/ default.aspx). 3,5,6,11,13,15 The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, and 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, and 0%-0.8% in the literature) were low and similar between the 2 data sets. The rates of blood product transfusion (36% in KID and 64% in Peds NSQIP) varied between the 2 data sets.…”

Section: Resultsmentioning

confidence: 99%

“…The use of these parameters to capture craniosynostosis surgery has been previously reported in the literature. 11,13 To restrict the data set to nonsyndromic cases of craniosynostosis, the same criteria for the ICD-9-CM diagnosis codes were applied to Peds NSQIP and KID (excluding codes for concomitant congenital malformations: 740.0-759.9 [except 756.0] and 524.0-524.9). It is important to note that our unit of analysis is patient discharge, not individual patients.…”

Section: Data Source and Statistical Analysis: Kidmentioning

confidence: 99%

“…Management is surgical, with procedure recommendations dependent on patient age, surgeon practice, and other clinical factors. 11,23 The reported rates of perioperative complications after craniosynostosis surgery vary. Published accounts often examine heterogeneous cohorts of patients across multiple years or epochs.…”

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confidence: 99%

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Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

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OBJECT Research conducted using large administrative data sets has increased in recent decades, but reports on the fidelity and reliability of such data have been mixed. The goal of this project was to compare data from a large, administrative claims data set with a quality improvement registry in order to ascertain similarities and differences in content. METHODS Data on children younger than 12 months with nonsyndromic craniosynostosis who underwent surgery in 2012 were queried in both the Kids’ Inpatient Database (KID) and the American College of Surgeons Pediatric National Surgical Quality Improvement Program (Peds NSQIP). Data from published clinical craniosynostosis surgery series are reported for comparison. RESULTS Among patients younger than 12 months of age, a total of 1765 admissions were identified in KID and 391 in Peds NSQIP in 2012. Only nonsyndromic patients were included. The mean length of stay was 3.2 days in KID and 4 days in Peds NSQIP. The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, 0%-0.8% in the literature) were low and similar between the 2 data sets. The reported rates of blood transfusion (36% in KID, 64% in Peds NSQIP, and 1.7%-100% in the literature) varied between the 2 data sets. CONCLUSIONS Both the KID and Peds NSQIP databases provide large samples of surgical patients, with more cases reported in KID. The rates of complications studied were similar between the 2 data sets, with the exception of blood transfusion events where the retrospective chart review process of Peds NSQIP captured almost double the rate reported in KID.

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Section: Resultsmentioning

confidence: 99%

Section: Data Source and Statistical Analysis: Kidmentioning

confidence: 99%

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Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

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“…No significant variations in overall or subgroup compliance rates were shown in subgroups of age, sex, type of insurance, and diagnosis, though there were significant differences in AP compliance by race. Findings of racial disparity in pediatric surgical care are not unique; 1,6,7 reasons for this disparity in AP compliance are unclear and warrant further study. As substratification with specific patient comorbidities was not conducted in this study, it may be that there were specific clinical concerns or indications requiring prolonged antibiotic use beyond the recommended < 24-hour duration in guidelines.…”

Section: Discussionmentioning

confidence: 95%

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Pan

Kuo

Luerssen

et al. 2015

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OBJECT This study explored antibiotic prophylaxis (AP) in pediatric patients undergoing intrathecal baclofen pump (ITBP) surgery and factors associated with perioperative AP compliance with clinical guidelines. METHODS Data were obtained from the Pediatric Health Information System. The study cohort comprised patients who underwent ITBP surgery within 3 days of admission, between July 1, 2004, and March 31, 2014, with a minimum prior screening period and follow-up of 180 days. Exclusion criteria were prior infection, antibiotic use within 30 days of admission, and/or missing financial data. Chi-square tests and multivariate logistic regressions were used to determine factors associated with compliance with AP guidelines in ITBP surgeries. RESULTS A total of 1,534 patients met the inclusion criteria; 91.5% received AP and 37.6% received dual coverage or more. Overall bundled compliance comprised 2 components: 1) perioperative antibiotic administration and 2) < 24-hour postoperative antibiotic course. The most frequently used antibiotics in surgery were cefazolin (n = 873, 62.2%) and vancomycin (n = 351, 25%). Documented bundled AP compliance rates were 70.2%, 62.0%, 66.0%, and 55.2% in West, South, Midwest, and Northeast regions of the US, respectively. Compared with surgeries in the Northeast, procedures carried out in the West (OR 2.0, 95% C11.4-2.9, p < 0.001), Midwest (OR 1.6, 95% C11.1-2.3, p = 0.007), and South (OR 1.5, 95% C11.1-2.0, p = 0.021) were more likely to have documented AP compliance. Black (OR 0.74, 95% CI 0.55-1.00, p = 0.05) and Hispanic (OR 0.63, 95% CI 0.47-0.86, p = 0.004) patients were less likely to have documented AP compliance in ITBP surgeries than white patients. There were no significant differences in compliance rate by age, sex, type of insurance, and diagnosis. AP process measures were associated with shorter length of stay, lower hospitalization costs, and lower 6-month rates of surgical infection/complication. One of the 2 noncompliance subgroups, missed preoperative antibiotic administration, was correlated with a significantly higher 6-month surgical complication/infection rate (27.03%) compared with bundled compliance (20.00%, p = 0.021). For the other subgroup, prolonged antibiotic use > 24 hours postoperatively, the rate was insignificantly higher (22.00%, p = 0.368). Thus, of direct relevance to practicing clinicians, missed preoperative antibiotics was associated with 48% higher risk of adverse complication/infection outcome in a 6-month time frame. Adjusted hospitalization costs associated with baclofen pump surgery differed significantly (p < 0.001) with respect to perioperative antibiotic practices: 22.83, 29.10, 37.66 (× 1000 USD) for bundled compliance, missed preoperative antibiotics, and prolonged antibiotic administration, respectively. CONCLUSIONS Significant variation in ITBP antibiotic prophylaxis was found. Documented AP compliance was associated with higher value of care, showing favorable clinical and financial outcomes. Of most impact to clinical outcome, missed preoperative antibiotics was significantly associated with higher risk of 6-month surgical complication/infection. Prolonged antibiotic use was associated with significantly higher hospital costs compared with those with overall bundled antibiotic compliance. Future research is warranted to examine factors associated with practice variation and how AP compliance is associated with outcomes and quality, aiming for improving delivery of care to pediatric patients undergoing ITBP procedures.

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“…This is not the first study to find differences in healthcare based on socioeconomic demographics in this US data set. Socioeconomic and racial disparities in pediatric subspecialty surgery have been described across specialties [21][22][23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

Transfrontal and Transsphenoidal Approaches to Pediatric Craniopharyngioma: A National Perspective

et al. 2017

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Introduction: This study compared transsphenoidal (TS) and transfrontal (TF) approaches to craniopharyngioma utilizing a national database. Methods: The Kids' Inpatient Database (2003, 2006, and 2009) was surveyed for patients with a diagnosis of craniopharyngioma who underwent a subset of surgical interventions to compare TS and TF surgery. Demographics, hospital variables, and complications/comorbidities were analyzed with multivariate regression. Results: 314 admissions (TS = 104, TF = 210) were identified. The mean age was 14.8 (TS) versus 9.8 (TF) years (p < 0.001). The mean number of diagnoses was 4.6 (TS) versus 6.2 (TF) (p < 0.001). Diabetes insipidus was associated with 38% (TS) and 69% (TF). Cerebrospinal fluid (CSF) leak affected 19% TS and 4% TF resections. Other complications and comorbidities included postoperative stroke (2% TS vs. 5% TF), panhypopituitarism (5 vs. 8%), death (0 vs. 1%), cranial nerve deficits (1 vs. 6%), thrombotic events (7 vs. 17%), and seizures (0 vs. 12%). 98% of patients were discharged home after a mean 6-day length of stay (LOS) after TS, whereas 90% of TF patients had a LOS of 12 days. TS cases were more likely to be privately insured (68%) and from higher income brackets (61%) than TF ones (56 and 2%, respectively) (p < 0.05). In multivariate regression models adjusting for age, sex, race, number of diagnoses, surgical approach, hospital volume, and insurance type, the TS approach was associated with an increased incidence of CSF leak (OR 10, p < 0.001). More documented diagnoses (OR 16-60, p < 0.01) and TF approach (OR 2.6, p < 0.01) were associated with an increased incidence of other complications and comorbidities. Age younger than 10 (β-coefficient 2.3, p = 0.01), more diagnoses (β-coefficient 1.2, p < 0.001), and TF approach (β- coefficient 3.0, p < 0.01) were associated with increased LOS. A higher number of diagnoses were associated with nonhome discharge destinations (β-coefficient 1.29, p < 0.001). Conclusion: TS surgery was associated with an increased incidence of CSF leak but shorter LOS; TF surgery was associated with an increased incidence of other complications. Patients undergoing TS surgery were more likely to have private insurance and a higher family income bracket.

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The Impact of Insurance, Race, and Ethnicity on Age at Surgical Intervention among Children with Nonsyndromic Craniosynostosis

Cited by 52 publications

References 45 publications

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Transfrontal and Transsphenoidal Approaches to Pediatric Craniopharyngioma: A National Perspective

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