Urology practice · 2025
Association of Hospital, Surgical, and Patient Factors With Cost of Pyeloplasty Admission in Children: Retrospective Analysis of the Pediatric Health Information System.
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Gan Zoe S, Mittal Sameer, Faerber Jennifer A, Huang Yuan-Shung, Johnson Marjorie, Shukla Aseem, Srinivasan Arun
Аннотация
INTRODUCTION: Factors influencing pyeloplasty surgical admission costs are not well understood. Our objectives were to (1) measure the relationship between pediatric pyeloplasty surgical volume and admission costs and (2) identify hospital, surgical, and patient factors associated with costs and length of stay (LOS) for pyeloplasty admission.
METHODS: We queried the Pediatric Health Information System multicenter billing database from 2012 to 2021 for patients aged younger than 18 who underwent open or robotic pyeloplasty based on International Classification of Diseases (ICD)-9, ICD-10, or Current Procedural Terminology codes. We tested the relationship between hospital-level pyeloplasty volume and total estimated resource-utilization costs for pyeloplasty admission using Spearman's correlation. We used generalized linear models with generalized estimating equations to obtain the adjusted association between each factor and total costs (log-gamma model) and LOS (negative binomial distribution). We report risk ratios and incidence rate ratios with robust variance estimates and 95% CI for the effects on total costs and LOS, respectively.
RESULTS: Of 13,233 patients undergoing pyeloplasty with a mean (SD) age of 6.6 (5.4) years, 5462 (41%) had robotic surgery. There was a small negative correlation between pyeloplasty volume and total admission costs (r = -0.017, P < .0001). Older age, comorbidities, public insurance, and lower Childhood Opportunity Index were associated with both longer LOS and higher costs. Surgical volume was associated with neither total cost nor LOS.
CONCLUSIONS: Higher pyeloplasty volume has a small correlation with lower total pyeloplasty admission costs. However, medical and social factors seem to be more closely related to admission costs and LOS than hospital volume or surgical approach.
METHODS: We queried the Pediatric Health Information System multicenter billing database from 2012 to 2021 for patients aged younger than 18 who underwent open or robotic pyeloplasty based on International Classification of Diseases (ICD)-9, ICD-10, or Current Procedural Terminology codes. We tested the relationship between hospital-level pyeloplasty volume and total estimated resource-utilization costs for pyeloplasty admission using Spearman's correlation. We used generalized linear models with generalized estimating equations to obtain the adjusted association between each factor and total costs (log-gamma model) and LOS (negative binomial distribution). We report risk ratios and incidence rate ratios with robust variance estimates and 95% CI for the effects on total costs and LOS, respectively.
RESULTS: Of 13,233 patients undergoing pyeloplasty with a mean (SD) age of 6.6 (5.4) years, 5462 (41%) had robotic surgery. There was a small negative correlation between pyeloplasty volume and total admission costs (r = -0.017, P < .0001). Older age, comorbidities, public insurance, and lower Childhood Opportunity Index were associated with both longer LOS and higher costs. Surgical volume was associated with neither total cost nor LOS.
CONCLUSIONS: Higher pyeloplasty volume has a small correlation with lower total pyeloplasty admission costs. However, medical and social factors seem to be more closely related to admission costs and LOS than hospital volume or surgical approach.