title: Practice patterns and resource utilization for infants with bladder exstrophy: a national perspective.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: anthony.schaeffer@childrens.harvard.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Schaeffer
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Emilie K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
mesh_terms: D001746:Bladder Exstrophy / Q000191:economics / Q000601:surgery*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
keywords: bladder exstrophy; costs and cost analysis; physician's practice patterns; utilization review