Medical Costs of Patients Undergoing Esophageal Atresia Repair are Mainly Influenced by Associated Malformations

Abstract

Background Esophageal atresia (EA) is a rare disease requiring surgical repair, usually within the first days of life. Patients with EA require intensive postoperative care and often have comorbidities. There is a lack of data on the costs incurred by patients with EA during the first year of life.

Methods Anonymized claims data were provided by the Techniker Krankenkasse (∼10.8 million clients). Data were extracted for patients who had an inpatient diagnosis of EA (International Classification of Diseases [ICD]: Q39.0 or Q39.1) and a reconstruction of the esophageal passage in case of atresia (Operationen-und Prozedurenschlüssel [German version of ICPM, International Classification of Procedures in Medicine; OPS] 5–428.0 to 5–428.7, 5–316.1 or 5–431.0) during their first hospital stay. All patients were in their first year of life at initial hospitalization (2016–2020) and were followed up for 1 year. Costs, length of hospital stay, and duration of mechanical ventilation and differentiated OPS services were analyzed using descriptive statistics. Multiple linear regression was used to analyze the determinants of hospital costs.

Results A total of 119 patients with EA were included (55.5% male). The mean cost of the 1-year observation period was €89,736 ± 97,419 (range €12,755–640,154). The increasing costs of the initial hospitalization led to a disproportionate increase in the costs of the 1-year observation period. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course (€193,103 ± 157,507 vs. €39,846 ± 33,473). The mean duration of mechanical ventilation was 23.2 ± 43.1 days and the mean length of hospital stay was 80.3 ± 77.2 days.

Conclusion To our knowledge, this is the first study to investigate the costs of EA patients in the first year of life. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course.

Keywords

esophageal atresia - economic - pediatric - congenital malformations - surgical complications

Publication History

Received: 27 May 2024

Accepted: 24 September 2024

Accepted Manuscript online:
25 September 2024

Article published online:
29 October 2024

• References

• 1 Evanovich DM, Wang JT, Zendejas B, Jennings RW, Bajic D. From the ground up: esophageal atresia types, disease severity stratification and survival rates at a single institution. Front Surg 2022; 9: 799052
• 2 Dingemann C, Dietrich J, Zeidler J. et al. Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million. Dis Esophagus 2016; 29 (07) 780-786
• 3 Lacher M, Barthlen W, Eckoldt F. et al. Operative volume of newborn surgery in German University hospitals: high volume versus low volume centers. Eur J Pediatr Surg 2022; 32 (05) 391-398
• 4 Betalli P, Cheli M, Colusso MM. et al. Association between Kasai portoenterostomy at low caseload centres and transplant complications in children with biliary atresia. J Pediatr Surg 2022; 57 (09) 223-228
• 5 Gasparella P, Singer G, Kienesberger B. et al. The Financial Burden of Surgery for Congenital Malformations-The Austrian Perspective. Int J Environ Res Public Health 2021; 18 (21) 11166
• 6 Apfeld JC, Kastenberg ZJ, Gibbons AT, Phibbs CS, Lee HC, Sylvester KG. The disproportionate cost of operation and congenital anomalies in infancy. Surgery 2019; 165 (06) 1234-1242
• 7 Techniker Krankenkasse. Gesundheitsreport 2021. Arbeitsunfähigkeiten. 2021 . Accessed October 3, 2024 at: https://www.tk.de/resource/blob/2103660/ffbe9e82aa11e0d79d9d6d6d88f71934/gesundheitsreport-au-2021-data.pdf
• 8 Temtamy SA, Miller JD. Extending the scope of the VATER association: definition of the VATER syndrome. J Pediatr 1974; 85 (03) 345-349
• 9 Dingemann C, Brendel J, Wenskus J. et al. Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula. BMC Pediatr 2020; 20 (01) 267
• 10 Shetty S, Kennea N, Desai P, Giuliani S, Richards J. Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England. Ann R Coll Surg Engl 2016; 98 (01) 56-60
• 11 Dingemann C, Eaton S, Aksnes G. et al. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: diagnostics, preoperative, operative, and postoperative management. Eur J Pediatr Surg 2020; 30 (04) 326-336
• 12 Dingemann C, Eaton S, Aksnes G. et al. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: follow-up and framework. Eur J Pediatr Surg 2020; 30 (06) 475-482
• 13 Dingemann C, Eaton S, Aksnes G. et al. ERNICA Consensus Conference on the Management of Patients with Long-Gap Esophageal Atresia: perioperative, surgical, and long-term management. Eur J Pediatr Surg 2021; 31 (03) 214-225