Pediatrics & Therapeutics
Open Access
ISSN: 2161-0665
+44 1478 350008
ISSN: 2161-0665
+44 1478 350008
Matthew L Stone
University of Virginia Health System, USA
Posters & Accepted Abstracts: Pediat Therapeut
The purpose of the study was to examine risk-adjusted associations between primary payer status and postoperative morbidity, mortality and resource utilization in pediatric surgical patients within the United States. A weighed total of 153,333 pediatric surgical patients were evaluated using the national Kid�s Inpatient Database (2003, 2006): appendectomy, intussusception, decortication, pyloromyotomy, congenital diaphragmatic hernia repair and colonic resection for Hirschsprung�s disease. Patients were stratified according to payer status: Medicare (n=180), Medicaid (n=51,862), uninsured (n=12,539) and private insurance (n=88,753). Multivariable hierarchical regression modeling was utilized to determine multivariable hierarchical regression modeling was utilized to evaluate risk-adjusted associations between payer status and outcomes. Overall median patient age was 12 years and appendectomies accounted for the highest proportion of cases (81.3%). After adjustment for patient, hospital and operation-related factors, payer status was independently associated with increased in-hospital death for uninsured patients (p<0.0001). Medicaid payer status was associated with increased risk for postoperative complications (p<0.02), adjusted lengths of stay and total hospital charges (p<0.001). Importantly, these results were dependent on operation type. Thus, primary payer status is associated with risk-adjusted postoperative mortality, morbidity and resource utilization among pediatric surgical patients. Uninsured patients are at increased risk for postoperative mortality while Medicaid patients accrue greater morbidity, hospital lengths of stay and total charges.