Trends in epidemiology and hospitalization utilization for myelomeningocele repair from 2000 to 2009.
OBJECTIVE
Although the incidence of myelomeningocele (MMC) has declined over the past decades with folic acid supplementation and prenatal screening, neural tube defects remain the most common birth defect in the USA. A majority of affected neonates require surgical repair. To characterize US trends in the epidemiology and hospital utilization of MMC repair over the past decade, we analyzed a nationally representative database.


METHODS
We queried the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) for all discharges with procedure code for MMC repair for the years 2000, 2003, 2006, and 2009. The cohorts from these time points were compared for their demographic and in-hospital variables. Results are reported as estimated frequencies and means with 95 % confidence intervals (CI).


RESULTS
Sex, race, insurance status, family income level, and mortality of affected infants have not changed significantly over the decade. A majority of neonatal MMC repairs occur in larger hospital bed size and more specialized children's hospital centers. Of patients, 52.3 to 60 % receive VPS placement during the same admission as the primary MMC repair. Total hospital costs for the MMC hospitalizations have remained relatively stable from 42,843 dollars in 2003 to 46,749 dollars in 2009 (adjusted to 2009 dollars).


CONCLUSIONS
Demographics of children having MMC repair have not changed significantly over the past decade, while these surgeries have become more concentrated in pediatric-specialized centers. There appears to be a plateau in public health and access advances with relatively stable cost of MMC hospital care.
Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Dominic A
DA
Harris
Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Jacob
J
Cherian
Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Melissa
M
LoPresti
Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Andrew
A
Jea
Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA. sandilam@gmail.com.|Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA. sandilam@gmail.com.
Sandi
S
Lam
D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States
Epidemiology; Myelomeningocele; Neural tube defect; Spina bifida