title: Disparities in clinical and economic outcomes in children and adolescents following surgery for tethered cord syndrome in the United States.
abstract: OBJECTIVE
  Tethered cord syndrome (TCS) is a common spinal abnormality. In this study, the authors analyzed demographics, complications, and outcomes in children and adolescents who underwent surgery for TCS.
  
  
  METHODS
  Using the national Kids' Inpatient Database (KID), the authors retrospectively identified patients with a primary diagnosis of TCS who were treated with spinal laminectomy and discharged in 2000, 2003, 2006, and 2009. Descriptive analysis was provided for patient- and hospital-level characteristics. Mortality, complications, non-routine discharges, in-hospital length of stay (LOS), and total charges were documented for the entire cohort and age-specific cohorts (0-5, 6-10, 11-15, and 16-20 years). Comparisons by complications and age groups were conducted.
  
  
  RESULTS
  A total of 7397 children and adolescents met the criteria in the 4 studied years. The mean age was 5.7 years; 55.3% of patients were younger than 5 years, 21.5% were 6-10 years, and 16.2% were 11-15 years. Most surgeries were performed in patients who were female (55.0%) and white (64.4%) and were performed at large (49.8%), teaching (94.2%), and urban (99.1%) children's (89.3%) hospitals. The trend showed an increase in prevalence from 2000 (19.9%) to 2009 (29.6%). Common comorbidities included anomalies in spinal curvature (16.7%), urinary or bladder dysfunction (14.3%), and spinal stenosis/spondylosis (1.4%). Non-routine discharges (3.3%) were significantly higher with advancing age, increasing from 2.2% in those younger than 5 years to 9.0% in those older than 15 years (p < 0.0001). There was a similar increasing trend for complications (6.8% to 13.9%, respectively, p < 0.0001) and average LOS (3.5 to 5.1 days, respectively, p < 0.0001). Hospital charges increased with age from an average of $28,521 in those younger than 5 years to $36,855 in those older than 15 years (p < 0.0001).
  
  
  CONCLUSIONS
  There was a steady trend of increasing operative treatment for TCS over the more recent years. The nationwide analysis was also indicative of an existing disparity, based on age, in complications, outcomes, and charges following TCS surgical correction. Older children tended to have more complications, longer LOS, more non-routine discharges, and higher hospital costs. The results are highly supportive of surgery at a younger age for this condition. Future research should investigate this correlation, especially considering the efforts to control and reduce health care costs.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles;
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.forename: Lutfi
authors.initials: L
authors.lastname: Al-Khouja
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Adamo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007297:Inpatients; D007796:Laminectomy / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D009436:Neural Tube Defects / Q000191:economics* / Q000601:surgery*; D010351:Patient Discharge; D012189:Retrospective Studies; D014481:United States
keywords: KID = Kids' Inpatient Database; LOS = length of stay; TCS = tethered cord syndrome; VATER = vertebral anomalies, imperforate anus, tracheoesophageal fistula, and renal-radial anomalies; adolescents; epidemiology; filum terminale; national study; pediatric; spine; tethered cord syndrome