EFFECTS OF HYDROCEPHALUS ON HOSPITAL USE, ASSOCIATED COSTS, AND ACCESS TO CARE AMONG CHILDREN WITH SPINA BIFIDA

Objectives: This study examined hospital resource use, including timeliness of surgical repair of spina bifida (SB), and geographical access to hospital care, by the presence of hydrocephalus, isolated or non-isolated SB, and selected sociodemographic characteristics among children with SB. Methods: This was a retrospective, statewide, population-based study of children with SB, born in Florida 1998-2007, identified by the Florida Birth Defects Registry and linked to hospital discharge records. Information about hospitalizations, lengths of stay, and costs were obtained from hospital discharge data for infants (<1 year) and children ages one to four years. Time to SB surgical repair was calculated using procedural codes and hospital discharge data. One-way travel time and distance to access hospital care were calculated using geocoded maternal residential addresses, hospital addresses, and Florida road networks. Chi-square tests and logistic, Poisson, generalized linear regression, and ordinary least squares were used to examine the study objectives. Models were adjusted for hydrocephalus; isolated (no other major birth defect) vs. non-isolated SB, and selected predisposing, enabling, and need characteristics Results: Of 614 children, 42.4% of children had isolated SB and hydrocephalus; 32.3% had isolated SB without hydrocephalus; 14.5% had non-isolated SB and hydrocephalus, and 10.9% had non-isolated SB without hydrocephalus. In adjusted results, infants with isolated SB and hydrocephalus had 53% more hospitalizations and 2.6 times the number of hospitalized days and costs compared with infants with isolated SB without hydrocephalus. Infants and children with non-isolated SB and hydrocephalus had twice the number of post-birth hospitalizations and hospitalized days than children with isolated SB without hydrocephalus, but only about 40% higher costs. Regarding timeliness of surgical repair, of 299 infants with a recorded repair, 68.6% had repair by day two, 15.1% had repair days three through seven, and 16.4% had repair after day seven. In adjusted results, hydrocephalus was the only characteristic associated with repair by day two (adjusted prevalence ratio=1.80, 95% confidence interval: 1.31-2.48). Of 612 children with a geocoded address, 56.4% of infants and 61.4% of children had a one-way average travel time of =30 minutes to hospitals. Infants with non-isolated SB and hydrocephalus traveled the longest to hospitals (mean: 60.8; median: 34.2; range 5- 494 minutes). In adjusted results, non-isolated SB, maternal minority race/ethnicity, lower maternal education, and rural residence were associated with lower likelihood of traveling =30 minutes to hospitals during infancy. Discussion: Comorbidities substantially increase hospital resource use for children with SB, particularly during infancy. Results also showed that the majority of infants with SB had a timely repair. Infants with non-isolated SB and hydrocephalus traveled the longest to access hospital care. Findings underscore the need to consider comorbidities when examining hospital resource use for children with SB and other birth defects. Results also demonstrate that birth defects registry data and GIS-based methods are useful to evaluate geographical access to hospitals for children with birth defects