title: Adults with myelomeningocele and other forms of spinal dysraphism: hospital care in the United States since the turn of the millennium.
abstract: OBJECTIVE The natural history and management of myelomeningocele (MM) in children is fairly well understood. There is a deficiency of knowledge regarding the care of adults, however, even though there are now more adults than children living with MM. The purpose of this study was to characterize the hospital care of adults with MM and hydrocephalus on a nationwide population base. Adults with other forms of spina bifida (SB) were studied for contrast. METHODS The Nationwide Inpatient Sample for the years 2001, 2004, 2007, and 2010 was queried for admissions with diagnostic ICD-9-CM codes for MM with hydrocephalus and for other forms of SB. RESULTS There were 4657 admissions of patients with MM and 12,369 admissions of patients with SB in the sample. Nationwide rates of admission increased steadily for both MM and SB patients throughout the study period. Hospital charges increased faster than the health care component of the Consumer Price Index. Patients with MM were younger than patients with SB, but annual admissions of MM patients older than 40 years increased significantly during the study period. With respect to hospital death and discharge home, outcomes of surgery for hydrocephalus were superior at high-volume hospitals. Patients with MM and SB were admitted to the hospital more frequently than the general population for surgery to treat degenerative spine disease. CONCLUSIONS Patients with MM and SB continue to require neurosurgical attention in adulthood, and the demand for services for older patients with MM is increasing. Management of hydrocephalus at high-volume centers is advantageous for this population. Patients with MM or SB may experience high rates of degenerative spine disease.
authors.affiliation: Division of Neurosurgery, Nemours Neuroscience Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware; and Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Piatt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D015994:Incidence; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics; D016135:Spinal Dysraphism / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: AHRQ = Agency for Healthcare Research and Quality; CCS = Clinical Classifications Software; HAC = hospital-acquired condition; HCUP = Healthcare Utilization Project; MM = myelomeningocele; NIS = Nationwide Inpatient Sample; Nationwide Inpatient Sample; SB = spina bifida; adults; congenital; hydrocephalus; myelomeningocele; spina bifida