Socioeconomic Disparity in the Surgical Management and Outcomes of Familial Adenomatous Polyposis (FAP) Disease at Children's Hospitals
*Briana Leung, Michael Tirabassi
Baystate Medical Center, Springfield, MA
Objective: To determine whether type of healthcare insurance correlated with differences in the surgical management of FAP and outcomes.
Design: Retrospective database study.
Patients: Using the 2016 HCUP Kids’ Inpatient Database (KID), discharges with a diagnosis of benign neoplasm of the colon (ICD-10-CM: D12.2-D12.6) and a procedure code of total abdominal colectomy (ICD-10-CM: 0DTE4ZZ & 0DTE0ZZ) or total proctocolectomy (ICD-10-CM: 0DTP4ZZ & 0DTP0ZZ) were identified. Out of 247 patients with a benign neoplasm diagnosis, 77(31.2%) underwent a total abdominal colectomy (TAC) or total proctocolectomy (TP).
Main Outcome Measures: The primary outcome measure was presence of postoperative complications. Secondary measures included age (<18 or ≥18 years old), income quartile (1st to 4th quartile), creation of ileostomy, total hospital charges and length of stay. Fisher’s exact test (alpha<0.2) was used to evaluate associations between insurance type and various measures.
Results: 40.3%(31/77) had Medicaid, 55.8%(43/77) had private insurance, and 2.6%(2/77) had other insurance. Medicaid was associated with being <18 years old at time of TAC or TP (p=0.029), creation of a diverting ileostomy (p=0.157), being in the lowest income quartile (p=0.092), and presence of a postoperative complication (p=0.159). Urinary retention and ileus were the most common complications. Medicaid was also associated with higher total charges (p=0.019) and greater length of stay (p=0.171).
Conclusions: Medicaid insurance correlated with various disparities in FAP management and outcomes compared to private insurance, including younger age at operation, presence of postoperative complication(s), higher costs, and longer length of stay.
| < 18 yo | Ileostomy | Low income | Complications | Median Cost | Median LOS (days) | |
| Medicaid | 77%(24/31) | 61%(19/31) | 36%(11/31) | 55%(17/31) | $99k | 6 |
| Private | 51%(22/43) | 42%(18/43) | 15%(5/43) | 37%(16/43) | $67k | 5 |
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