Comparing cost and complications of primary and staged surgical repair of neonatally diagnosed Hirschsprung's disease.
OBJECTIVE
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.
Shinall
Myrick C
MC
Department of Pediatric Surgery,Vanderbilt University School of Medicine, Nashville, TN 37232-9780, USA. ricky.shinall@vanderbilt.edu
Koehler
Elizabeth
E
Shyr
Yu
Y
Lovvorn
Harold N
HN
D003125:Colostomy / Q000191:economics*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000191:economics / Q000601:surgery*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology