Abstract
Chiari I malformation is a common entity in pediatric neurosurgery. Prior studies have shown that surgical treatment at children’s hospitals (CH) is associated with higher costs compared to non-children’s hospitals (NCH) for other diagnoses. Therefore, we hypothesized that costs would be increased for the treatment of Chiari I malformation at a CH. Data were extracted from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID). Patients who underwent surgery for Chiari I malformation were identified using International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. Univariate statistical tests, multivariable linear regression models, and propensity score matching were utilized to determine differences in hospital length of stay (LOS) and costs between patients treated at CH versus NCH.Treatment at a CH was associated with significantly higher costs compared to treatment at an NCH while hospital LOS and mortality were similar. In the multivariable linear regression model, the adjusted average cost for surgical treatment of Chiari I malformation was $13,716, and treatment at a CH was associated with an additional $6,343 (p<0.0001). Similar results were seen after propensity score matching: costs for treatment at a CH were $6,047 higher than they were for treatment at an NCH (p<0.0001). In our analysis, a significant increase in cost was seen with treatment at a CH while controlling for patient demographics and hospital characteristics, as well as imbalanced covariates between the cohorts. Further investigation is warranted to determine the drivers of increased cost outside of the patient and hospital characteristics we analyzed in our study.
Highlights
Chiari I malformation is a common pediatric neurosurgical issue
We found that length of stay (LOS) was similar between cohorts, the cost of treatment was significantly higher at children’s hospitals (CH) compared to non-children’s hospitals (NCH)
This study demonstrated that for a large national cohort, the cost of surgical treatment for pediatric Chiari I malformation patients was higher at CHs when compared to NCHs
Summary
Chiari I malformation is a common pediatric neurosurgical issue. the prevalence of Chiari I malformation is difficult to estimate, epidemiological studies suggest that it occurs in 0.7% to 3.6% of the U.S population [1,2,3]. For a number of surgical and nonsurgical diagnoses, studies using national samples have yielded evidence that treatment in a free-standing CH is associated with higher costs relative to treatment at other hospitals [6,7,8,9,10,11]. Increased costs may be associated with more complex or challenging patients and may or may not lead to improved outcomes. This has not been fully elucidated in the literature. The goal of this study was to compare the cost of patients undergoing surgery for Chiari I malformation at CHs versus NCHs using a national sample and controlling for potentially confounding variables and selection bias due to imbalanced covariates
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