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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Cerebrospinal fluid shunt placement in the pediatric population: a model of hospitalization cost
Sandi K Lam1, Visish M Srinivasan, Thomas G Luerssen
1Division of Pediatric Neurosurgery, Texas Children's Hospital; and.
Insights
Pediatric hydrocephalus shunt surgery costs are influenced by patient socioeconomic factors like race and income, alongside hospital characteristics such as nurse staffing and location. Understanding these drivers is key for developing accurate cost models.
Area of Science:
- Neurosurgery
- Health Economics
- Pediatric Healthcare
Background:
- Hydrocephalus is a common neurological condition in children requiring cerebrospinal fluid (CSF) shunt surgery.
- Cost drivers for pediatric CSF shunt surgery have not been extensively analyzed on a large scale.
- Developing a cost model is essential for understanding and managing healthcare expenditures.
Purpose of the Study:
- To develop a cost model for hospitalization expenses associated with pediatric CSF shunt surgery.
- To identify risk factors contributing to increased costs in these procedures.
Main Methods:
- Utilized data from the 2009 Kids' Inpatient Database (KID).
- Analyzed factors influencing costs, including patient demographics, hospital characteristics, and clinical data.
- Employed multivariate linear regression models to characterize cost per inpatient day (CoPID).
Main Results:
- Included 2519 pediatric patients undergoing initial CSF shunt placement.
- Average cost was $49,317 with an average length of stay (LOS) of 18.2 days.
- Identified child age, hydrocephalus etiology, admission timing, comorbidities, hospital type, RN staffing, procedures, race, insurance, income, and region as significant cost-associated factors.
Conclusions:
- Patient socioeconomic status (race, income, insurance) significantly impacts CSF shunt surgery costs.
- Hospital-level factors (RN FTEs, hospital type, region) also play a crucial role in cost determination.
- Nonclinical factors should be considered in pediatric CSF shunt placement cost models.
Unlabelled:
OBJECT There have been no large-scale analyses on cost drivers in CSF shunt surgery for the treatment of pediatric hydrocephalus. The objective of this study was to develop a cost model for hospitalization costs in pediatric CSF shunt surgery and to examine risk factors for increased costs.
Methods:
Data were extracted from the Kids' Inpatient Database (KID) of the Healthcare Cost and Utilization Project. Children with initial CSF shunt placement in the 2009 KID were examined. Patient charge was converted to cost using a cost-to-charge ratio. The factors associated with costs of CSF shunt hospitalizations were examined, including patient demographics, hospital characteristics, and clinical data. The natural log transformation of cost per inpatient day (CoPID) was analyzed. Three multivariate linear regression models were used to characterize the cost. Variance inflation factor was used to identify multicollinearity for each model.
Results:
A total of 2519 patients met the inclusion criteria and were included in study. Average cost and length of stay (LOS) for initial shunt placement were $49,317 ± $74,483 (US) and 18.2 ± 28.5 days, respectively. Cost per inpatient day was $4249 ± $2837 (median $3397, range $80-$22,263). The average number of registered nurse (RN) full-time equivalents (FTEs) per 1000 adjusted inpatient days was 5.8 (range 1.6-10.8). The final model had the highest adjusted coefficient of determination (R(2) = 0.32) and was determined to be the best among 3 models. The final model showed that child age, hydrocephalus etiology, weekend admission, number of chronic diseases, hospital type, number of RN FTEs per 1000 adjusted inpatient days, number of procedures, race, insurance type, income level, and hospital regions were associated with CoPID.
Conclusions:
A patient's socioeconomic status, such as race, income level, and insurance, in addition to hospital-related factors such as number of hospital RN FTEs, hospital type, and US region, could affect the costs of initial CSF shunt placement, in addition to clinical factors such as hydrocephalus origin and LOS. To create a cost model of initial CSF shunt placement in the pediatric population, consideration of such nonclinical factors may be warranted.
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