Paediatric spina bifida inpatient treatment at Wellington Regional Hospital: a cost analysis of sequential patients

To sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida, and to review operations requiring general anaesthesia and radiological investigations of patients undergoing surgical management for spina bifida.

Six sequential adolescents with spina bifida managed through the paediatric surgical services at Wellington Regional Hospital (Wellington, New Zealand) from November 2008 to November 2009 were sampled for retrospective analysis. One neonatal case was also chosen. All hard copy notes, radiology packets, electronic notes and radiological studies were requested and reviewed for these seven patients covering all lifetime admissions. Inpatient length of stay and operation costs were also analysed.

Six adolescent patients(10-21 years) had undergone a total of 124 operations requiring general anaesthesia--average 20.67 (19-28). There were 125 admissions in total for this group--average 20.83 (14-34) with an average length of stay of 8.53 days per admission and an average cumulative length of stay of 177.67 days. As a group, the adolescents had spent 1066 days as inpatients. Adolescents received an average of 75.33 (36-164) radiological procedures, including an average of 7.5 CT scans (4-13). The neonate had 10 operations, four admissions, 67 radiological investigations and a total length of stay of 194 days. The average cumulative cost per adolescent was NZ$944,000 ($472,000-$1,202,000) with a total cost of NZ$5,664,000. The cost for the neonate was NZ$678,340.

This study found inpatient costs for paediatric spina bifida patients were significantly higher than the only previous estimate carried out in New Zealand. This study also shows the burden on patients and their families/whanau in the high numbers of admissions, major operations, long periods spent as inpatients and the high number of radiological investigations.