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Hospital Care for Children With Neuromuscular Spine Disease in the United States: Utilization, Charges,
Muhammad Ghauri1, Ryan Sindewald2, Misa Fang3
1School of Medicine, California University of Science and Medicine, Colton, CA.
Insights
Pediatric neuromuscular scoliosis (NMS) hospitalizations surged over 30-fold, increasing costs significantly. Strategies to reduce complications are vital for managing this growing healthcare burden.
Area of Science:
- Pediatric Orthopedics
- Healthcare Management
- Spinal Surgery
Background:
- The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) provides nationally representative data on pediatric hospitalizations.
- Pediatric neuromuscular scoliosis (NMS) represents a significant orthopedic challenge in children.
Purpose of the Study:
- To analyze trends in healthcare utilization, costs, and outcomes for pediatric NMS in the US from 2003 to 2019.
- To identify predictors of perioperative complications in pediatric NMS patients undergoing spinal fusion.
Main Methods:
- Retrospective cross-sectional study using the KID database.
- Analysis of hospitalizations for spinal fusion in NMS patients across multiple years (2003-2019).
- Calculation of national estimates for admissions, charges, length of stay, and hospital days; logistic regression for complication predictors.
Main Results:
- NMS admissions increased over 30-fold, with total charges rising to $1.31 billion and mean charges per hospitalization increasing.
- Median length of stay remained stable at 8 days, but hospital days increased substantially.
- Perioperative complications were associated with transfer status and insurance type; older age and Black race were linked to lower complication rates.
Conclusions:
- Pediatric NMS care has become significantly more resource-intensive over two decades, primarily due to increased procedure costs.
- Despite low mortality and stable length of stay, the economic burden is substantial.
- Reducing perioperative complications is key to mitigating the economic impact on this patient population.
Study Design:
Retrospective cross-sectional study.
Objective:
We analyzed inpatient health care utilization, costs, and outcomes for pediatric neuromuscular scoliosis (NMS) in the US from 2003 to 2019. We describe hospitalization characteristics and identify predictors of perioperative complications.
Summary Of Background Data:
The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) collects nationally representative weighted data samples of pediatric hospital discharges.
Methods:
We identified hospitalizations related to spinal fusion procedures for NMS in children from 2003, 2006, 2009, 2012, 2016, and 2019. Hospitalizations were categorized as surgical (initial spinal fusion, wound dehiscence, wound infection) and complication-related (pneumonia, urinary tract infection, paralytic ileus, respiratory failure). Weighted national estimates of admissions, inflation-adjusted charges (2019 USD), length of stay (LOS), and hospital days were calculated. Survey-weighted logistic regression identified independent predictors of perioperative complications.
Results:
Admissions for NMS rose >30-fold from 235 in 2006 to 7242 in 2019. Total charges increased from $22 million to $1.31 billion, and the mean charge per hospitalization increased from $99,700 to $182,100. Hospital days increased from 1942 to 58,528, and median LOS remained consistent at 8 days. In 2019, NMS accounted for 0.1% of pediatric admissions, 0.25% of hospital days, and 0.6% of hospital charges in the United States. Surgical wound complications were <0.5% of encounters but incurred mean charges exceeding $456,000 and median LOS of 30 days. Among 15,821 weighted encounters, overall mortality was 0.7%. The likelihood of perioperative complications was higher among children transferred from another facility or covered by public or "other" insurance, whereas age older than or equal to 10 years and Black race were associated with lower odds of complications ( P <0.05).
Conclusions:
Over the past two decades, pediatric NMS has become substantially more resource-intensive, driven particularly by rising procedure costs, despite stable LOS and low mortality. Strategies for reducing perioperative complications may mitigate the economic burden of this vulnerable population.
Level Of Evidence:
Level IV.
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