Department of Surgery, Stanford University School of Medicine, CA, USA; Department of Surgery, Cleveland Clinic Foundation, OH, USA.
Department of Surgery, Stanford University School of Medicine, CA, USA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, CA, USA.
Surgery. 2019 Jun;165(6):1234-1242. doi: 10.1016/j.surg.2018.12.022. Epub 2019 May 3.
Congenital anomalies are the leading cause of infant death and pediatric hospitalization, but existing estimates of the associated costs of health care are either cross-sectional surveys or economic projections. We sought to determine the percent of total hospital health care expenditures attributable to major anomalies requiring surgery within the first year of life.
Utilizing comprehensive California statewide data from 2008 to 2012, cohorts of infants undergoing major surgery, with birth defects and with surgical anomalies, were constructed alongside a referent group of newborns with no anomalies or operations. Cost-to-charge and physician fee ratios were used to estimate hospital and professional costs, respectively. For each cohort, costs were broken down according to admission, birth episode, and first year of life, with additional stratifications by birth weight, gestational age, and organ system.
In total, 68,126 of 2,205,070 infants (3.1%) underwent major surgery (n = 32,614) or had a diagnosis of a severe congenital anomaly (n = 57,793). These accounted for $7.7 billion of the $18.9 billion (40.7%) of the total health care costs/expenditures of the first-year-of-life hospitalizations, $7.0 billion (48.6%) of the costs for infants with comparatively long birth episodes, and $5.2 billion (54.7%) of the total neonatal intensive care unit admission costs. Infants with surgical anomalies (n = 21,264) totaled $4.1 billion (21.7%) at $80,872 per infant. Cardiovascular and gastrointestinal diseases accounted for most admission costs secondary to major surgery or congenital anomalies.
In a population-based cohort of infant births compared with other critically ill neonates, surgical congenital anomalies are disproportionately costly within the United States health care system. The care of these infants, half of whom are covered by Medi-Cal or Medicaid, stands as a particular focus in an age of reform of health care payments.
先天性异常是导致婴儿死亡和儿科住院的主要原因，但现有的医疗保健相关成本估计要么是横断面调查，要么是经济预测。我们旨在确定在生命的第一年需要手术的主要异常导致的总医院医疗保健支出的百分比。
利用 2008 年至 2012 年的加利福尼亚州全州综合数据，构建了接受主要手术、有先天性缺陷和手术异常的婴儿队列，以及没有异常或手术的新生儿参照组。使用成本与收费比和医生费用比分别估计医院和专业成本。对于每个队列，根据入院、分娩事件和生命的第一年，分别对成本进行了细分，并按出生体重、胎龄和器官系统进行了进一步细分。
总共有 2205070 名婴儿中的 68126 名（3.1%）接受了主要手术（n=32614）或患有严重先天性异常的诊断（n=57793）。这些占第一年住院治疗总健康保健费用/支出的 1890 亿美元的 77 亿美元（40.7%），占出生时间较长的婴儿的 70 亿美元（48.6%）的费用和新生儿重症监护病房总入院费用的 520 亿美元（54.7%）。接受手术的异常婴儿（n=21264）每个婴儿花费 41 亿美元（21.7%），每个婴儿花费 80872 美元。心血管和胃肠道疾病是因主要手术或先天性异常而导致的大部分入院费用的主要原因。
在与其他重病新生儿相比的婴儿出生人口基础队列中，先天性手术异常在美国医疗保健系统中不成比例地昂贵。这些婴儿的护理，其中一半由 Medi-Cal 或 Medicaid 覆盖，在医疗保健支付改革的时代，成为一个特别关注的焦点。
