Comparing cost and complications of primary and staged surgical repair of neonatally diagnosed Hirschsprung's disease.

Shinall MC, Koehler E, Shyr Y, Lovvorn HN
J Pediatr Surg. 2008 43 (12): 2220-5

PMID: 19040939 · DOI:10.1016/j.jpedsurg.2008.08.048

BACKGROUND/PURPOSE - We questioned whether primary surgical correction of neonatally diagnosed Hirschsprung's Disease (HD) incurs higher costs or increased incidence of adverse events (AE) when compared with staged repair.

METHODS - We reviewed the medical records of all neonates diagnosed with HD at our institution between 1997 and 2007. Sixty subjects fulfilled criteria for inclusion. Twenty-seven neonates had primary repair, and 33 had staged repair. We measured inflation-adjusted total costs, direct costs, and total charges and 6 AE between the 2 groups. A generalized linear model was used to examine differences between group variables.

RESULTS - We found no statistically significant difference in costs or AE between primary and staged repair. Inflation-adjusted median financial data for primary or staged repair were, respectively, as follows: total costs, $35,670 vs $38,538 (P = .617); direct costs, $18,453 vs $23,937 (P = .128); total charges, $107,315 vs $102,492 (P = .690). Adverse events occurred in 48% of primary repair subjects and 36% of staged repair subjects (P = .434); no single AE differed significantly between the two groups.

CONCLUSIONS - We found no statistical evidence that primary neonatal correction of HD adds cost or risk of AE when compared with a traditional staged approach in neonates who met inclusion criteria.

MeSH Terms (18)

Colostomy Cost-Benefit Analysis Direct Service Costs Female Follow-Up Studies Hirschsprung Disease Hospital Charges Hospital Costs Hospitals, Pediatric Hospitals, University Humans Infant, Newborn Laparoscopy Length of Stay Male Postoperative Complications Retrospective Studies Tennessee

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