title: Morbidity and healthcare costs of vascular anomalies: a national study.
abstract: OBJECTIVE
  This study aimed to define morbidities and costs related to modern-day medical care for children with vascular anomalies.
  
  
  METHODS
  We reviewed the 2003-2009 Kids' Inpatient Database for pediatric patients (age < 21 years) hospitalized with hemangioma, arteriovenous malformation (AVM), or lymphatic malformation (LM). Patient characteristics, hospital complications, and hospital charges were compared by vascular anomaly type. Multivariable linear regression modeling was used to determine predictors of increasing hospital costs for patients with AVMs.
  
  
  RESULTS
  In total, 7485 pediatric inpatients with vascular anomalies were identified. Frequently associated complications included chronic anemia (4.0%), sepsis (4.6%), and hypertension (2.4%). Children with AVM had the highest rate of in-hospital mortality, compared to those with hemangiomas or LM (1.0% vs. 0.1% vs. 0.3%, p < 0.001). AVMs were also associated with the highest median hospital charge, more than twice the cost for hemangiomas or LM ($45,875 vs. $18,909 vs. $18,919; p < 0.001).
  
  
  CONCLUSIONS
  There is a significant rate of morbidity in children with vascular anomalies, most often from blood loss and infection. The greater cost of AVM care may be related to the higher mortality rate, associated complications, and complexity of procedures required treating them. Cost-effective management of vascular anomalies should target prevention and the early recognition of both chronic comorbidities and acute complications.
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA. jina.kim1@duke.edu.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Duke University School of Medicine, Durham, USA.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Leraas
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Uttara P
authors.initials: UP
authors.lastname: Nag
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Benrashid
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Allori
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Waleska M
authors.initials: WM
authors.lastname: Pabon-Ramos
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Shortell
authors.affiliation: Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Elisabeth T
authors.initials: ET
authors.lastname: Tracy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D010372:Pediatrics / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
keywords: Arteriovenous malformation; Child; Healthcare costs; Hemangioma; Lymphatic abnormalities