P1.013: Impact of Payer Status on Pediatric Inpatient Craniotomies Costs and Outcomes

Background: Craniotomies are surgical procedures where a portion of the skull is removed. Historically, pediatric craniotomy accounts for 40.5/10,000 pediatric hospitalizations and is one of the most expensive diagnoses in pediatric hospitalization, with average charges ranging from $40,000 to $50,000 per stay. Our study aims to understand how payer status may influence access, expose outcome disparities, and highlight systemic quality gaps for this procedure.

Methods: We conducted a retrospective study of hospitalized children diagnosed with craniotomy using the Agency for Healthcare Research and Quality (AHRQ) 2022 Kids’ Inpatient Database (KID) with 5,660,863 weighted pediatric discharges, representing the national estimate of pediatric hospitalizations from 3,811 hospitals across 48 participating states. Craniotomy diagnoses are characterized by the All Patient Refined Diagnosis-Related Groups (APR-DRG) of 20 and 21: craniotomy for trauma and craniotomy except for trauma. APR-DRG validated severity classes segmented illness severity. Statistical analysis used Stata 16.1 to generate nationally representative estimates incorporating discharge weights from the stratified sample design. Institutional Review Board exemption due to deidentified nature of study.

Results: There were 13,020 weighted discharges (9,556 observations) within APR-DRG 20 and 21 encompassing Medicaid (46.2%) and Private (53.8%) payers. In general, gender and age of the populations were comparable (Medicaid versus Private: 41.5% vs. 44.5% female, 9.7 versus 10.9 years). Medicaid payers had higher total charges, length of stay, and numbers of procedures performed per weighted discharge ($283,859 vs. $237,460, 12.7 vs 9.0 days, and 5.1 vs 4.4 procedures). Interestingly, for lower severity of illness, Medicaid had lower charges with the highest severity level 4 being the only one with Medicaid having higher charges ($610,113 vs $516,053). However, for length of stay, Medicaid was consistently higher (3.7 vs 3.3, 5.4 vs 5.0, 12.4 vs 11.2, and 30.2 vs 23.7). Lastly, for the number of procedures performed, Medicaid had a higher number of procedures for severity classes 3 (5.3 vs 5.0) and 4 (9.4 vs. 8.7) only.

Conclusion: Our study found that for pediatric patients with craniotomies, those with Medicaid had higher total charges, longer hospital stays, and more procedures than pediatric patients with commercial insurance. By isolating severity, we found that pediatric Medicaid patients with greater severity had more cost and more procedures than pediatric patients with commercial insurance. In comparison, the length of stay was higher for pediatric Medicaid patients, irrespective of severity. Thus, our study suggests that providers may approach pediatric Medicaid patients with craniotomies differently than those with commercial insurance, leading to cost and outcome disparities.