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. 2014 May;191(5):1381-8.
doi: 10.1016/j.juro.2013.11.054. Epub 2013 Dec 1.

Practice patterns and resource utilization for infants with bladder exstrophy: a national perspective

Anthony J Schaeffer  1 , Emilie K Johnson  2 , Tanya Logvinenko  3 , Dionne A Graham  3 , Joseph G Borer  2 , Caleb P Nelson  2
Affiliations

Practice patterns and resource utilization for infants with bladder exstrophy: a national perspective

Anthony J Schaeffer et al. J Urol. 2014 May.

Abstract

Purpose: Substantial variability exists in bladder exstrophy care, and little is known about costs associated with the condition. We define the care patterns and first year cost for patients with bladder exstrophy at select freestanding pediatric hospitals in the United States.

Materials and methods: We used the Pediatric Health Information System database to identify patients with bladder exstrophy born between January 1999 and December 2010 who underwent primary closure in the first 120 days of life. Demographic, surgical, postoperative and cost data for all encounters were assessed. Multivariate linear regression was used to examine the association between patient, surgeon and hospital characteristics and costs.

Results: Of the 381 patients who underwent primary closure within the first 120 days of life 279 (73%) did so within the first 3 days of life. A total of 119 patients (31%) underwent pelvic osteotomy, including 51 of 279 (18%) who underwent closure within the first 3 days of life, 38 of 67 (56%) who underwent closure between 4 and 30 days of life, and 30 of 35 (86%) who underwent closure between 31 and 120 days of life (p = 0.0017). Median inflation adjusted, first year cost in United States dollars per patient was $66,577 (IQR $45,335 to $102,398). Presence of nonrenal comorbidity and completion of primary closure after 30 days of life increased first year costs by 24% and 53%, respectively. Increased post-closure length of stay was associated with greater costs.

Conclusions: At select freestanding United States pediatric hospitals the majority of bladder exstrophy closures are performed within the first 3 days of life. Most, but not all, patients undergoing closure after the neonatal period undergo osteotomy. The presence of nonrenal comorbidity and increased postoperative length of stay are associated with greater costs.

Keywords: bladder exstrophy; costs and cost analysis; physician's practice patterns; utilization review.

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Figures

Figure 1
Figure 1
Number of primary bladder exstrophy closures per year in PHIS database by hospital
Figure 2
Figure 2
Quarterly distribution of total patient cost in the first year of life Each dot represents an individual patient *indicates truncated data
See this image and copyright information in PMC

Comment in

  • Editorial comment.
    Gearhart JP, Dicarlo HN. Gearhart JP, et al. J Urol. 2014 May;191(5):1387. doi: 10.1016/j.juro.2013.11.115. Epub 2014 Jan 30. J Urol. 2014. PMID: 24486092 No abstract available.

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