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Pediatric Intrathecal Baclofen Pumps: A Descriptive Analysis of Hospital Course and Associated Costs
Jonathan Dallas1,2, Robert P Naftel2,3, Chevis N Shannon2,3
1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Predictors of increased cost and length-of-stay (LOS) after intrathecal baclofen pump (ITBP) placement were identified. Complications, comorbidities, and hospital characteristics significantly influenced patient outcomes and healthcare expenses.
Area of Science:
- Neurosurgery
- Health Economics
- Health Services Research
Background:
- Intrathecal baclofen pump (ITBP) placement is a critical intervention for managing spasticity.
- Understanding cost and length-of-stay (LOS) drivers is essential for optimizing patient care and resource allocation.
Purpose of the Study:
- To identify key predictors associated with increased healthcare costs and postoperative length-of-stay (LOS) following ITBP placement.
- To analyze national trends in resource utilization for ITBP procedures.
Main Methods:
- Retrospective analysis of the 2009/2012 Kids' Inpatient Database.
- Inclusion of patients with infantile cerebral palsy undergoing ITBP insertion.
- Utilized nonparametric univariate analysis and gamma log-link general linear modeling to identify significant predictors (p < 0.05).
Main Results:
- Increased LOS was associated with hospital ITBP volume, small hospital size, device/procedural complications, additional procedures, electrolyte abnormalities, and neurological comorbidities.
- Decreased LOS was linked to paralysis, Northeastern hospital region, and investor-owned hospital status.
- Increased costs were predicted by Hispanic/other race, Northeast region, small/medium hospital sizes, additional procedures, neurological comorbidities, and longer LOS; decreased costs were associated with Western region, government, and investor-owned hospitals.
Conclusions:
- Multiple variables significantly predict increased cost and LOS after ITBP placement.
- The study highlights national trends in cost drivers for ITBP procedures, emphasizing the impact of complications and hospital characteristics.
Introduction:
The purpose of this study was to identify predictors of increased cost and postoperative length-of-stay (LOS) following intrathecal baclofen pump (ITBP) placement.
Methods:
Patients were derived from the 2009/2012 kids' inpatient database. Inclusion criteria were selected for patients with ICD-9 codes 343.X (infantile cerebral palsy), 86.06 (infusion pump insertion), 03.90 (spinal catheter insertion), and elective hospitalizations. Nonparametric univariate analysis and subsequent gamma log-link general linear modeling were used to identify significant predictors of cost/LOS (p < 0.05).
Results:
529 unweighted patients (787 with survey weights applied) met criteria. Median LOS was 3.00 days, and median cost was USD 23,284. Following multivariate modeling, predictors of increased LOS (in days) included increased hospital ITBP volume (p = 0.027), small hospital size (+0.55, p = 0.004), device complications (+0.95, p < 0.001), procedural complications (+1.40, p < 0.001), additional procedures (+0.86, p < 0.001), electrolyte abnormalities (+3.74, p < 0.001), and neurological comorbidities (+1.60, p < 0.001). Factors associated with decreased LOS were paralysis (-0.53, p < 0.001), Northeastern hospital region (-0.55, p = 0.018), and investor-owned hospital status (-0.75, p = 0.001). Similarly, predictors of increased cost included race of Hispanic (+USD 1,156, p = 0.033) or "other" (+USD 2,158, p = 0.001), Northeast hospital region (+USD 4,120, p < 0.001), small (+USD 4,139, p < 0.001) or medium (+USD 3,368, p < 0.001) hospital sizes, additional procedures (+USD 1,649, p < 0.001), neurological comorbidities (+USD 3,222, p = 0.003), and increased LOS (p < 0.001). Factors associated with decreased cost included Western hospital region (-USD 1,594, p = 0.001), government hospitals (-USD 1,391, p = 0.019), and investor-owned hospitals (-USD 2,057, p = 0.021).
Conclusion:
This study found multiple variables associated with increased cost/LOS following ITBP placement. Broadly, this analysis demonstrates national trends associated with increased cost following ITBP placement.
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