Insurance type impacts bronchoscopy for foreign body aspiration: An analysis of the Kids' Inpatient Database

To ascertain whether insurance type is associated with postoperative adverse effects and hospital length of stay for inpatient airway foreign body removal.

Retrospective analysis of children <18 years of age that underwent inpatient bronchoscopy with removal of airway foreign body in the national Healthcare Cost and Utilization Project Kid's Inpatient Database (KID). Postoperative outcomes and length of stay were analyzed for racial disparities and insurance type using multivariable logistic regression and negative binomial regression. Models adjusted for race, insurance type, sex, age, and presence of pulmonary risk factors.

A total of 5,850 children underwent bronchoscopy for foreign body removal. The median age was 2 (IQR: 4-1) years and 61.6% patients were male. Payer status included Medicaid (38.9%), private insurance (51.5%), self-pay (4.3%) and other (9.6%). The Medicaid cohort had a higher proportion of black (19.1%) and Hispanic patients (34.5%) (P < 0.001). Children covered under Medicaid had higher odds of postoperative complications (odds ratio [OR] 1.216; P = 0.031) and a greater length of stay (OR 1.533; P < 0.001) relative to the private insurance group when adjusting for sex, age, race and presence of pulmonary risk factors. The odds of having a greater length of stay was 33% higher for black (P < 0.001) and 37% higher for Hispanic (P < 0.001) children compared to white children. The average adjusted LOS under Medicaid was 8.37 days compared to 5.46 days for privately insured children.

This study demonstrated that a difference in postoperative complications and LOS exist between public and privately insured children for foreign body removal via bronchoscopy. Further studies are warranted to investigate factors that drive these disparities.