title: Excess costs and length of hospital stay attributable to perioperative respiratory events in children.
abstract: BACKGROUND
  Knowledge of the excess hospital costs and prolonged length of stay attributable to perioperative respiratory event (PRE) in pediatric anesthesia is useful for hospital planning. In this study, we compared costs (excess hospital costs and indirect costs) and length of hospital stay between children who had PRE and did not have PRE for noncardiac surgery at a tertiary care hospital in southern Thailand.
  
  
  METHODS
  A prospective matched cohort study was conducted in children aged <15 years who underwent general anesthesia between November 2012 and December 2013 at Songklanagarind Hospital. PRE children were matched with no PRE children (1:1) using a random selection procedure on outpatients/inpatients, type of surgery, surgical charge (baht), ASA physical status, age difference <9 years, and difference in time of surgery <6 months. Primary end points were excess hospital costs and number of days hospitalized after surgery. Number of days hospitalized after surgery, excess hospital costs and indirect costs regarding transportation, and income loss of parents between groups were compared using Wilcoxon signed rank test. Any hospital stay after surgery between groups was compared using McNemar χ test. A hurdle model was used to predict any hospital stay and number of days hospitalized after surgery. Multiple mixed-effects linear regression was used to identify predictors of adjusted excess hospital costs and indirect costs.
  
  
  RESULTS
  A total 430 children were included (215 matched pairs). More PRE children required hospital stay after surgery (81% vs 72%, P = 0.004), and PRE children had a longer number of days hospitalized after surgery (median [interquartile ranges]: 1 [1-3.5] vs 1 [0-2]; P < 0.001) and incurred higher excess costs (P < 0.001) but not indirect costs (P = 0.23). In multivariate analysis, PRE was a significant predictor for hospital stay after surgery (odds ratio, 2.56; 95% confidence interval, 1.23-5.31), longer hospitalization (count ratio, 2.10 [1.31-3.35]), higher excess costs (cost ratio, 1.30 [1.12-1.53]), and indirect cost (cost ratio, 1.58 [1.20-2.08]) after adjusting for patient and anesthesia characteristics. Universal coverage (74%) was associated with 35% and 64% higher excess cost compared with the Comptroller General's Department (17%) and self-pay (7%), respectively (P = 0.003).
  
  
  CONCLUSIONS
  The effects of PRE in pediatric anesthesia were hospital stay after surgery, 2 times longer hospitalization, 30% higher excess hospital costs, and 58% higher indirect cost among outpatients. Hospital policy to efficiently manage hospital beds and compensatory budget should be developed.
authors.affiliation: From the *Department of Anesthesiology and †Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Maliwan
authors.initials: M
authors.lastname: Oofuvong
authors.forename: Alan Frederick
authors.initials: AF
authors.lastname: Geater
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.forename: Thavat
authors.initials: T
authors.lastname: Chanchayanon
authors.forename: Bussarin
authors.initials: B
authors.lastname: Sriyanaluk
authors.forename: Boonthida
authors.initials: B
authors.lastname: Saefung
authors.forename: Kanjana
authors.initials: K
authors.lastname: Nuanjun
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000191:economics* / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000191:economics* / Q000453:epidemiology*; D012737:Sex Factors; D013785:Thailand / Q000453:epidemiology