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Healthcare Utilization and Comorbidities Associated with Anorectal Malformations in the United States
Karlo Kovacic1, Sravan R Matta1, Katja Kovacic1
1Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Insights
Most children with anorectal malformations have other congenital anomalies, increasing healthcare costs. Prompt recognition and multidisciplinary management are crucial for these complex cases.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Healthcare Economics
Background:
- Anorectal malformations (ARM) are complex congenital anomalies.
- Associated anomalies significantly impact patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To determine the nationwide prevalence of anorectal malformations and associated anomalies in children.
- To analyze healthcare utilization and expenditure for these conditions.
Main Methods:
- Utilized the Kids' Inpatient Database (2006, 2009, 2012).
- Identified patients using International Classification of Diseases, Ninth Revision (ICD-9) codes for ARM and associated anomalies.
- Employed weighted analysis for prevalence and cost estimations.
Main Results:
- Identified 2396 children under 2 years with ARM; 80% had additional congenital anomalies.
- Urogenital (38.5%), cardiac (21.2%), and vertebral (8.6%) anomalies were most common.
- Associated anomalies significantly increased length of stay and costs, totaling $45.5 million annually.
Conclusions:
- The majority of children with ARM present with complex co-occurring anomalies requiring prompt recognition.
- Lifelong multidisciplinary management for these complex cases incurs substantial healthcare expenditure.
- Findings support improved healthcare resource allocation and planning for pediatric ARM management.
Objective:
To determine nationwide prevalence and healthcare utilization in children with anorectal malformations and associated anomalies over a 6-year period.
Study Design:
We used the Kids' Inpatient Database for the years 2006, 2009, and 2012 for data collection. International Classification of Diseases, Ninth Revision codes were used to identify patients with anorectal malformations and associated anomalies.
Results:
A total of 2396 children <2 years of age with anorectal malformations were identified using weighted analysis; 54.3% of subjects were male. The ethnic subgroups were 40.1% white, 23.6% Hispanic, 9.3% African American, and 27% other ethnicity. Other congenital anomalies were reported in 80% of anorectal malformations and were closely associated with increased length of stay and costs. A genetic disorder was identified in 14.1% of the sample. Urogenital anomalies were present in 38.5%, heart anomalies in 21.2%, and 8.6% had vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and limb defects association. Anorectal malformations with other anomalies including vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and limb defects association incurred significant hospital charges when compared with anorectal malformations alone. The average annual healthcare expenditure for surgical correction of anorectal malformations and associated anomalies for the 3 years was US $45.5 million.
Conclusions:
This large, major nationally representative study shows that majority of children with anorectal malformations have additional congenital anomalies that deserve prompt recognition. The high complexity and need for lifelong multidisciplinary management is associated with substantial healthcare expenditure. This information complements future healthcare resource allocation and planning for management of children with anorectal malformations.
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