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In this study, conducted at Wellington Regional Hospital (Wellington, New Zealand), we aimed to sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida.Methods To obtain the most representative sample possible of the patient base, it was decided to choose six sequential contacts with the paediatric surgical service at Wellington Regional Hospital from November 2008 to 2009 (admissions and outpatient visits). Ethics approval was obtained. Hard copy notes and radiology were reviewed, as well as electronic, notes and radiological procedures. Admissions, length of stay, radiological procedures and, frequency, nature and durations of surgical operations were calculated. An operation was defined as a procedure requiring general anaesthesia (GA). Therefore, MRI or CT scans requiring GA were included in the operations tally. Sample size was restricted to 7 patients because of the enormous time resource required to analyse large volumes of records. Costings (inpatient only) were analysed. These were calculated by average daily inpatient cost multiplied by length of stay. Operative costs calculated by theatre utilization time and disposables cost per procedure. Results The numbers of operations requiring GA on each adolescent are summarised in Table 1, showing an average of 20.67 operations (17-28) and a total of 124. Table 1. Number of operations on adolescent patients Adolescent Number of operations (requiring general anaesthesia) 1 2 3 4 5 6 25 28 (+1c) 17 18 17 19 Total 124 Average 20.67 Note: +1c refers to one cancelled operation, which was not included in the final tally. Table 2. Neonatal operations Neonate Number of operations (requiring general anaesthesia) 1 10 Table 3 summarises the admissions and total lengths of stay as hospital inpatients. As a group, the six adolescents in this study had cumulatively spent 1066 days in hospital as inpatients, averaging 177.67 days (75-272). There had been a total of 125 individual admissions to Wellington Regional Hospital, with an average of 20.83 (14-34). The average length of stay per admission was 8.53 days (5.36-12.36). Table 3. Adolescent admissions and lengths of stay (LOS) Adolescent Number of admissions Cumulative LOS (d) LOS per admission (d) 1 2 3 4 5 6 34 23 14 15 22 17 252 155 75 184 272 128 7.41 6.74 5.36 12.27 12.36 7.53 Total 125 1066 Average 20.83 177.67 8.53 Admission details for the neonate are shown in Table 4. There were four admissions overall, with a total length of stay of 194 days. It is important to highlight that this is longer than the average length of stay for the adolescent patients reviewed. Table 5 and 6 summarise the radiological procedures undergone by the patients in our study. The most important findings are the high number of procedures with radiation exposure. Adolescent patients had had on average 55.67 X-rays (23-141), 7.5 CT scans (4-13) and four nuclear medicine investigations (0-9). The neonate had had 34 X-rays, but no CT or nuclear medicine investigations. Table 4. Neonatal admissions and length of stay (LOS) Neonate Admissions NICU (d) HDU (d) Total LOS LOS per admission 1 4 5 21 194 48.5 Table 5. Adolescent radiological procedures Patient X-ray USS CT MRI Nuclear med Total 1 2 3 4 5 6 141 20 46 38 66 23 10 5 0 1 7 8 9 5 13 4 5 9 1 3 4 3 6 0 2 3 2 0 9 8 164 36 65 46 93 48 Total 334 31 45 17 24 452 Average 55.67 5.17 7.5 2.83 4 75.33 Table 6. Neonatal radiological procedures Neonate X-ray USS MRI Total radiology 1 34 23 3 67 Table 7. Adolescent costing Adolescent Total cost ($NZ) 1 2 3 4 5 6 1,202,000 902,000 472, 000 956,000 1,070,000 1,062,000 Total 5,664,000 Average 944,000 Table 8. Neonatal costing Neonate Total cost ($NZ) 1 678,340 Tables 7 and 8 show the cumulative costs of adolescent and neonatal inpatient treatment inpatient at Wellington Regional Hospital. The average cost of adolescent treatment—including operative costs and inpatient stay—was NZ$944,000 ($472,000-$1,202,000). Costs for the neonate amounted to NZ$678,340. Discussion This is a pilot study, carried out in one New Zealand paediatric tertiary surgical centre. The results demonstrate the enormous morbidity faced by these children and their families. Six of the seven patients are paraplegic. Children can expect to spend almost half a year in hospital by the time of their late adolescent years. Almost all will (in addition to initial spinal cord closure) require repeated neurosurgical procedures for shunts as well as major bladder, bowel and orthopaedic spine surgery. These procedures prevent deterioration of disability levels rather than restoring normal function. The vast majority of admissions were for surgical reasons and intensive, skilled nursing is required. It is to be noted we did not analyse costs outside the Wellington paediatric inpatient service. Four patients came from provincial towns but admissions to their local hospitals were not included. The costings in this study are likely to significantly underestimate the true costs of treating inpatient paediatric spina bifida patients for this and other reasons. The study was conservative in its estimates in order to avoid ‘double dipping’. Although during the data collection all laboratory investigations were accounted for, the costs for same were not calculated, rather they were seen to be included in the costs for a day of stay. Secondly the inpatient ward costs for these children would be at the higher end of a range but average inpatient case mix costs were used. There were many costs that were outside of our scope, for which we did not gather data. These include costs incurred to peripheral hospitals, as well as costs associated with prenatal and obstetric care, district nursing, social work, special education, transport, wheelchairs and mobility aids, orthotics, physiotherapy, occupational therapy and outpatient consultations. Social costs to the family such as loss of parental employment were also not calculated. All children with spina bifida undergoing surgery are treated with full latex-free theatre precautions which lengthens theatre times considerably. Overall, therefore, our measured costs despite being considerable represent the tip of an iceberg. Even with this highly conservative estimate, the cost analysis still showed that paediatric spina bifida inpatient management is significantly more expensive than the only previous New Zealand estimate. In an unpublished study that has been quoted in reports by the Food Standards Australia New Zealand (FSANZ),1 Singh & Elliot indicated that the cost of patient care for spina bifida in New Zealand up to the age of 20 was NZ$355,060. A US study, similarly quoted by FSANZ,1 estimated that the direct and indirect costs of treating patients with spina bifida over their lifetime was NZ$565,000. Our series shows that the average cost to date for an adolescent (inpatient care alone) under 21 is $944,000. This is far higher than previously thought. The neonatal case reviewed demonstrates the high cost and morbidity

Summary

Abstract

Aim

To sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida, and to review operations requiring general anaesthesia and radiological investigations of patients undergoing surgical management for spina bifida.

Method

Six sequential adolescents with spina bifida managed through the paediatric surgical services at Wellington Regional Hospital (Wellington, New Zealand) from November 2008 to November 2009 were sampled for retrospective analysis. One neonatal case was also chosen. All hard copy notes, radiology packets, electronic notes and radiological studies were requested and reviewed for these seven patients covering all lifetime admissions. Inpatient length of stay and operation costs were also analysed.

Results

Six adolescent patients(10-21 years) had undergone a total of 124 operations requiring general anaesthesiaaverage 20.67 (19-28). There were 125 admissions in total for this groupaverage 20.83 (14-34) with an average length of stay of 8.53 days per admission and an average cumulative length of stay of 177.67 days. As a group, the adolescents had spent 1066 days as inpatients. Adolescents received an average of 75.33 (36-164) radiological procedures, including an average of 7.5 CT scans (4-13). The neonate had 10 operations, four admissions, 67 radiological investigations and a total length of stay of 194 days. The average cumulative cost per adolescent was NZ$944,000 ($472,000-$1,202,000) with a total cost of NZ$5,664,000. The cost for the neonate was NZ$678,340.

Conclusion

This study found inpatient costs for paediatric spina bifida patients were significantly higher than the only previous estimate carried out in New Zealand. This study also shows the burden on patients and their families/wh nau in the high numbers of admissions, major operations, long periods spent as inpatients and the high number of radiological investigations.

Author Information

Brendon Bowkett, Consultant Paediatric Surgeon, Paediatrics Department Capital Coast District Health Board, Wellington; Eamonn Deverall, Trainee Intern, University of Otago, Palmerston North Hospital, Palmerston North

Acknowledgements

We thank the patients and their families for participating in this study as well as Linda Gadd for assistance with retrieving notes.

Correspondence

Mr Brendon Bowkett.

Correspondence Email

b.bowkett@paradise.net.nz

Competing Interests

None declared.

Food Standards Australia New Zealand (FSANZ). Final Report Proposal P295: Consideration of Mandatory Fortification with Folic Acid (4 October 2006).Bowkett BD, Kelly EW. Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema. Paediatric Surgery International 2009;25(6):507-512.Rice HE, Frush DP, Farmer D, Waldhausen JH. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. Journal of Pediatric Surgery 2007;42:603-607.Austin JC. Long term risks of bladder augumentation in paediatric patients. Current Opinion in Urology 2008;18:408-412.Husmann D, Ray K. Bladder cancer: does augmentation cystoplasty increase the risk of bladder cancer. Nature Reviews Urology 2010Dec;7:648.Barf HA, Verhoef M, Jennekens-Schinkel MW, et al. Cognitive status of young adults with spina bifida. Developmental Medicine and Child Neurology 2003;45:813.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

In this study, conducted at Wellington Regional Hospital (Wellington, New Zealand), we aimed to sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida.Methods To obtain the most representative sample possible of the patient base, it was decided to choose six sequential contacts with the paediatric surgical service at Wellington Regional Hospital from November 2008 to 2009 (admissions and outpatient visits). Ethics approval was obtained. Hard copy notes and radiology were reviewed, as well as electronic, notes and radiological procedures. Admissions, length of stay, radiological procedures and, frequency, nature and durations of surgical operations were calculated. An operation was defined as a procedure requiring general anaesthesia (GA). Therefore, MRI or CT scans requiring GA were included in the operations tally. Sample size was restricted to 7 patients because of the enormous time resource required to analyse large volumes of records. Costings (inpatient only) were analysed. These were calculated by average daily inpatient cost multiplied by length of stay. Operative costs calculated by theatre utilization time and disposables cost per procedure. Results The numbers of operations requiring GA on each adolescent are summarised in Table 1, showing an average of 20.67 operations (17-28) and a total of 124. Table 1. Number of operations on adolescent patients Adolescent Number of operations (requiring general anaesthesia) 1 2 3 4 5 6 25 28 (+1c) 17 18 17 19 Total 124 Average 20.67 Note: +1c refers to one cancelled operation, which was not included in the final tally. Table 2. Neonatal operations Neonate Number of operations (requiring general anaesthesia) 1 10 Table 3 summarises the admissions and total lengths of stay as hospital inpatients. As a group, the six adolescents in this study had cumulatively spent 1066 days in hospital as inpatients, averaging 177.67 days (75-272). There had been a total of 125 individual admissions to Wellington Regional Hospital, with an average of 20.83 (14-34). The average length of stay per admission was 8.53 days (5.36-12.36). Table 3. Adolescent admissions and lengths of stay (LOS) Adolescent Number of admissions Cumulative LOS (d) LOS per admission (d) 1 2 3 4 5 6 34 23 14 15 22 17 252 155 75 184 272 128 7.41 6.74 5.36 12.27 12.36 7.53 Total 125 1066 Average 20.83 177.67 8.53 Admission details for the neonate are shown in Table 4. There were four admissions overall, with a total length of stay of 194 days. It is important to highlight that this is longer than the average length of stay for the adolescent patients reviewed. Table 5 and 6 summarise the radiological procedures undergone by the patients in our study. The most important findings are the high number of procedures with radiation exposure. Adolescent patients had had on average 55.67 X-rays (23-141), 7.5 CT scans (4-13) and four nuclear medicine investigations (0-9). The neonate had had 34 X-rays, but no CT or nuclear medicine investigations. Table 4. Neonatal admissions and length of stay (LOS) Neonate Admissions NICU (d) HDU (d) Total LOS LOS per admission 1 4 5 21 194 48.5 Table 5. Adolescent radiological procedures Patient X-ray USS CT MRI Nuclear med Total 1 2 3 4 5 6 141 20 46 38 66 23 10 5 0 1 7 8 9 5 13 4 5 9 1 3 4 3 6 0 2 3 2 0 9 8 164 36 65 46 93 48 Total 334 31 45 17 24 452 Average 55.67 5.17 7.5 2.83 4 75.33 Table 6. Neonatal radiological procedures Neonate X-ray USS MRI Total radiology 1 34 23 3 67 Table 7. Adolescent costing Adolescent Total cost ($NZ) 1 2 3 4 5 6 1,202,000 902,000 472, 000 956,000 1,070,000 1,062,000 Total 5,664,000 Average 944,000 Table 8. Neonatal costing Neonate Total cost ($NZ) 1 678,340 Tables 7 and 8 show the cumulative costs of adolescent and neonatal inpatient treatment inpatient at Wellington Regional Hospital. The average cost of adolescent treatment—including operative costs and inpatient stay—was NZ$944,000 ($472,000-$1,202,000). Costs for the neonate amounted to NZ$678,340. Discussion This is a pilot study, carried out in one New Zealand paediatric tertiary surgical centre. The results demonstrate the enormous morbidity faced by these children and their families. Six of the seven patients are paraplegic. Children can expect to spend almost half a year in hospital by the time of their late adolescent years. Almost all will (in addition to initial spinal cord closure) require repeated neurosurgical procedures for shunts as well as major bladder, bowel and orthopaedic spine surgery. These procedures prevent deterioration of disability levels rather than restoring normal function. The vast majority of admissions were for surgical reasons and intensive, skilled nursing is required. It is to be noted we did not analyse costs outside the Wellington paediatric inpatient service. Four patients came from provincial towns but admissions to their local hospitals were not included. The costings in this study are likely to significantly underestimate the true costs of treating inpatient paediatric spina bifida patients for this and other reasons. The study was conservative in its estimates in order to avoid ‘double dipping’. Although during the data collection all laboratory investigations were accounted for, the costs for same were not calculated, rather they were seen to be included in the costs for a day of stay. Secondly the inpatient ward costs for these children would be at the higher end of a range but average inpatient case mix costs were used. There were many costs that were outside of our scope, for which we did not gather data. These include costs incurred to peripheral hospitals, as well as costs associated with prenatal and obstetric care, district nursing, social work, special education, transport, wheelchairs and mobility aids, orthotics, physiotherapy, occupational therapy and outpatient consultations. Social costs to the family such as loss of parental employment were also not calculated. All children with spina bifida undergoing surgery are treated with full latex-free theatre precautions which lengthens theatre times considerably. Overall, therefore, our measured costs despite being considerable represent the tip of an iceberg. Even with this highly conservative estimate, the cost analysis still showed that paediatric spina bifida inpatient management is significantly more expensive than the only previous New Zealand estimate. In an unpublished study that has been quoted in reports by the Food Standards Australia New Zealand (FSANZ),1 Singh & Elliot indicated that the cost of patient care for spina bifida in New Zealand up to the age of 20 was NZ$355,060. A US study, similarly quoted by FSANZ,1 estimated that the direct and indirect costs of treating patients with spina bifida over their lifetime was NZ$565,000. Our series shows that the average cost to date for an adolescent (inpatient care alone) under 21 is $944,000. This is far higher than previously thought. The neonatal case reviewed demonstrates the high cost and morbidity

Summary

Abstract

Aim

To sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida, and to review operations requiring general anaesthesia and radiological investigations of patients undergoing surgical management for spina bifida.

Method

Six sequential adolescents with spina bifida managed through the paediatric surgical services at Wellington Regional Hospital (Wellington, New Zealand) from November 2008 to November 2009 were sampled for retrospective analysis. One neonatal case was also chosen. All hard copy notes, radiology packets, electronic notes and radiological studies were requested and reviewed for these seven patients covering all lifetime admissions. Inpatient length of stay and operation costs were also analysed.

Results

Six adolescent patients(10-21 years) had undergone a total of 124 operations requiring general anaesthesiaaverage 20.67 (19-28). There were 125 admissions in total for this groupaverage 20.83 (14-34) with an average length of stay of 8.53 days per admission and an average cumulative length of stay of 177.67 days. As a group, the adolescents had spent 1066 days as inpatients. Adolescents received an average of 75.33 (36-164) radiological procedures, including an average of 7.5 CT scans (4-13). The neonate had 10 operations, four admissions, 67 radiological investigations and a total length of stay of 194 days. The average cumulative cost per adolescent was NZ$944,000 ($472,000-$1,202,000) with a total cost of NZ$5,664,000. The cost for the neonate was NZ$678,340.

Conclusion

This study found inpatient costs for paediatric spina bifida patients were significantly higher than the only previous estimate carried out in New Zealand. This study also shows the burden on patients and their families/wh nau in the high numbers of admissions, major operations, long periods spent as inpatients and the high number of radiological investigations.

Author Information

Brendon Bowkett, Consultant Paediatric Surgeon, Paediatrics Department Capital Coast District Health Board, Wellington; Eamonn Deverall, Trainee Intern, University of Otago, Palmerston North Hospital, Palmerston North

Acknowledgements

We thank the patients and their families for participating in this study as well as Linda Gadd for assistance with retrieving notes.

Correspondence

Mr Brendon Bowkett.

Correspondence Email

b.bowkett@paradise.net.nz

Competing Interests

None declared.

Food Standards Australia New Zealand (FSANZ). Final Report Proposal P295: Consideration of Mandatory Fortification with Folic Acid (4 October 2006).Bowkett BD, Kelly EW. Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema. Paediatric Surgery International 2009;25(6):507-512.Rice HE, Frush DP, Farmer D, Waldhausen JH. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. Journal of Pediatric Surgery 2007;42:603-607.Austin JC. Long term risks of bladder augumentation in paediatric patients. Current Opinion in Urology 2008;18:408-412.Husmann D, Ray K. Bladder cancer: does augmentation cystoplasty increase the risk of bladder cancer. Nature Reviews Urology 2010Dec;7:648.Barf HA, Verhoef M, Jennekens-Schinkel MW, et al. Cognitive status of young adults with spina bifida. Developmental Medicine and Child Neurology 2003;45:813.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

In this study, conducted at Wellington Regional Hospital (Wellington, New Zealand), we aimed to sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida.Methods To obtain the most representative sample possible of the patient base, it was decided to choose six sequential contacts with the paediatric surgical service at Wellington Regional Hospital from November 2008 to 2009 (admissions and outpatient visits). Ethics approval was obtained. Hard copy notes and radiology were reviewed, as well as electronic, notes and radiological procedures. Admissions, length of stay, radiological procedures and, frequency, nature and durations of surgical operations were calculated. An operation was defined as a procedure requiring general anaesthesia (GA). Therefore, MRI or CT scans requiring GA were included in the operations tally. Sample size was restricted to 7 patients because of the enormous time resource required to analyse large volumes of records. Costings (inpatient only) were analysed. These were calculated by average daily inpatient cost multiplied by length of stay. Operative costs calculated by theatre utilization time and disposables cost per procedure. Results The numbers of operations requiring GA on each adolescent are summarised in Table 1, showing an average of 20.67 operations (17-28) and a total of 124. Table 1. Number of operations on adolescent patients Adolescent Number of operations (requiring general anaesthesia) 1 2 3 4 5 6 25 28 (+1c) 17 18 17 19 Total 124 Average 20.67 Note: +1c refers to one cancelled operation, which was not included in the final tally. Table 2. Neonatal operations Neonate Number of operations (requiring general anaesthesia) 1 10 Table 3 summarises the admissions and total lengths of stay as hospital inpatients. As a group, the six adolescents in this study had cumulatively spent 1066 days in hospital as inpatients, averaging 177.67 days (75-272). There had been a total of 125 individual admissions to Wellington Regional Hospital, with an average of 20.83 (14-34). The average length of stay per admission was 8.53 days (5.36-12.36). Table 3. Adolescent admissions and lengths of stay (LOS) Adolescent Number of admissions Cumulative LOS (d) LOS per admission (d) 1 2 3 4 5 6 34 23 14 15 22 17 252 155 75 184 272 128 7.41 6.74 5.36 12.27 12.36 7.53 Total 125 1066 Average 20.83 177.67 8.53 Admission details for the neonate are shown in Table 4. There were four admissions overall, with a total length of stay of 194 days. It is important to highlight that this is longer than the average length of stay for the adolescent patients reviewed. Table 5 and 6 summarise the radiological procedures undergone by the patients in our study. The most important findings are the high number of procedures with radiation exposure. Adolescent patients had had on average 55.67 X-rays (23-141), 7.5 CT scans (4-13) and four nuclear medicine investigations (0-9). The neonate had had 34 X-rays, but no CT or nuclear medicine investigations. Table 4. Neonatal admissions and length of stay (LOS) Neonate Admissions NICU (d) HDU (d) Total LOS LOS per admission 1 4 5 21 194 48.5 Table 5. Adolescent radiological procedures Patient X-ray USS CT MRI Nuclear med Total 1 2 3 4 5 6 141 20 46 38 66 23 10 5 0 1 7 8 9 5 13 4 5 9 1 3 4 3 6 0 2 3 2 0 9 8 164 36 65 46 93 48 Total 334 31 45 17 24 452 Average 55.67 5.17 7.5 2.83 4 75.33 Table 6. Neonatal radiological procedures Neonate X-ray USS MRI Total radiology 1 34 23 3 67 Table 7. Adolescent costing Adolescent Total cost ($NZ) 1 2 3 4 5 6 1,202,000 902,000 472, 000 956,000 1,070,000 1,062,000 Total 5,664,000 Average 944,000 Table 8. Neonatal costing Neonate Total cost ($NZ) 1 678,340 Tables 7 and 8 show the cumulative costs of adolescent and neonatal inpatient treatment inpatient at Wellington Regional Hospital. The average cost of adolescent treatment—including operative costs and inpatient stay—was NZ$944,000 ($472,000-$1,202,000). Costs for the neonate amounted to NZ$678,340. Discussion This is a pilot study, carried out in one New Zealand paediatric tertiary surgical centre. The results demonstrate the enormous morbidity faced by these children and their families. Six of the seven patients are paraplegic. Children can expect to spend almost half a year in hospital by the time of their late adolescent years. Almost all will (in addition to initial spinal cord closure) require repeated neurosurgical procedures for shunts as well as major bladder, bowel and orthopaedic spine surgery. These procedures prevent deterioration of disability levels rather than restoring normal function. The vast majority of admissions were for surgical reasons and intensive, skilled nursing is required. It is to be noted we did not analyse costs outside the Wellington paediatric inpatient service. Four patients came from provincial towns but admissions to their local hospitals were not included. The costings in this study are likely to significantly underestimate the true costs of treating inpatient paediatric spina bifida patients for this and other reasons. The study was conservative in its estimates in order to avoid ‘double dipping’. Although during the data collection all laboratory investigations were accounted for, the costs for same were not calculated, rather they were seen to be included in the costs for a day of stay. Secondly the inpatient ward costs for these children would be at the higher end of a range but average inpatient case mix costs were used. There were many costs that were outside of our scope, for which we did not gather data. These include costs incurred to peripheral hospitals, as well as costs associated with prenatal and obstetric care, district nursing, social work, special education, transport, wheelchairs and mobility aids, orthotics, physiotherapy, occupational therapy and outpatient consultations. Social costs to the family such as loss of parental employment were also not calculated. All children with spina bifida undergoing surgery are treated with full latex-free theatre precautions which lengthens theatre times considerably. Overall, therefore, our measured costs despite being considerable represent the tip of an iceberg. Even with this highly conservative estimate, the cost analysis still showed that paediatric spina bifida inpatient management is significantly more expensive than the only previous New Zealand estimate. In an unpublished study that has been quoted in reports by the Food Standards Australia New Zealand (FSANZ),1 Singh & Elliot indicated that the cost of patient care for spina bifida in New Zealand up to the age of 20 was NZ$355,060. A US study, similarly quoted by FSANZ,1 estimated that the direct and indirect costs of treating patients with spina bifida over their lifetime was NZ$565,000. Our series shows that the average cost to date for an adolescent (inpatient care alone) under 21 is $944,000. This is far higher than previously thought. The neonatal case reviewed demonstrates the high cost and morbidity

Summary

Abstract

Aim

To sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida, and to review operations requiring general anaesthesia and radiological investigations of patients undergoing surgical management for spina bifida.

Method

Six sequential adolescents with spina bifida managed through the paediatric surgical services at Wellington Regional Hospital (Wellington, New Zealand) from November 2008 to November 2009 were sampled for retrospective analysis. One neonatal case was also chosen. All hard copy notes, radiology packets, electronic notes and radiological studies were requested and reviewed for these seven patients covering all lifetime admissions. Inpatient length of stay and operation costs were also analysed.

Results

Six adolescent patients(10-21 years) had undergone a total of 124 operations requiring general anaesthesiaaverage 20.67 (19-28). There were 125 admissions in total for this groupaverage 20.83 (14-34) with an average length of stay of 8.53 days per admission and an average cumulative length of stay of 177.67 days. As a group, the adolescents had spent 1066 days as inpatients. Adolescents received an average of 75.33 (36-164) radiological procedures, including an average of 7.5 CT scans (4-13). The neonate had 10 operations, four admissions, 67 radiological investigations and a total length of stay of 194 days. The average cumulative cost per adolescent was NZ$944,000 ($472,000-$1,202,000) with a total cost of NZ$5,664,000. The cost for the neonate was NZ$678,340.

Conclusion

This study found inpatient costs for paediatric spina bifida patients were significantly higher than the only previous estimate carried out in New Zealand. This study also shows the burden on patients and their families/wh nau in the high numbers of admissions, major operations, long periods spent as inpatients and the high number of radiological investigations.

Author Information

Brendon Bowkett, Consultant Paediatric Surgeon, Paediatrics Department Capital Coast District Health Board, Wellington; Eamonn Deverall, Trainee Intern, University of Otago, Palmerston North Hospital, Palmerston North

Acknowledgements

We thank the patients and their families for participating in this study as well as Linda Gadd for assistance with retrieving notes.

Correspondence

Mr Brendon Bowkett.

Correspondence Email

b.bowkett@paradise.net.nz

Competing Interests

None declared.

Food Standards Australia New Zealand (FSANZ). Final Report Proposal P295: Consideration of Mandatory Fortification with Folic Acid (4 October 2006).Bowkett BD, Kelly EW. Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema. Paediatric Surgery International 2009;25(6):507-512.Rice HE, Frush DP, Farmer D, Waldhausen JH. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. Journal of Pediatric Surgery 2007;42:603-607.Austin JC. Long term risks of bladder augumentation in paediatric patients. Current Opinion in Urology 2008;18:408-412.Husmann D, Ray K. Bladder cancer: does augmentation cystoplasty increase the risk of bladder cancer. Nature Reviews Urology 2010Dec;7:648.Barf HA, Verhoef M, Jennekens-Schinkel MW, et al. Cognitive status of young adults with spina bifida. Developmental Medicine and Child Neurology 2003;45:813.

Contact diana@nzma.org.nz
for the PDF of this article

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