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Shah NR, Price A, Mobli K, O'Leary S, Radhakrishnan RS. Temporal Trends of Neonatal Surgical Conditions in Texas and Accessibility to Pediatric Surgical Care. J Surg Res 2024; 296:29-36. [PMID: 38215674 DOI: 10.1016/j.jss.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Texas consistently accounts for approximately 10% of annual national births, the second highest of all US states. This temporal study aimed to evaluate incidences of neonatal surgical conditions across Texas and to delineate regional pediatric surgeon accessibility. METHODS The Texas Birth Defects Registry was queried from 1999 to 2018, based on 11 well-established regions. Nine disorders (30,476 patients) were identified as being within the operative scope of pediatric surgeons: biliary atresia (BA), pyloric stenosis (PS), Hirschsprung's disease, stenosis/atresia of large intestine/rectum/anus, stenosis/atresia of small intestine, tracheoesophageal fistula/esophageal atresia, gastroschisis, omphalocele, and congenital diaphragmatic hernia. Annual and regional incidences were compared (/10,000 births). Statewide pediatric surgeons were identified through the American Pediatric Surgical Association directory. Regional incidences of neonatal disorder per surgeon were evaluated from 2010 to 2018 as a surrogate for provider disparity. RESULTS PS demonstrated the highest incidence (14.405/10,000), while BA had the lowest (0.707/10,000). Overall, incidences of PS and BA decreased significantly, while incidences of Hirschsprung's disease and small intestine increased. Other diagnoses remained stable. Regions 2 (48.24/10,000) and 11 (47.79/10,000) had the highest incidence of neonatal conditions; Region 6 had the lowest (34.68/10,000). Three rural regions (#2, 4, 9) lacked pediatric surgeons from 2010 to 2018. Of regions with at least one surgeon, historically underserved regions (#10, 11) along the Texas-Mexico border consistently had the highest defect per surgeon rates. CONCLUSIONS There are temporal and regional differences in incidences of neonatal conditions treated by pediatric surgeons across Texas. Improving access to neonatal care is a complex issue that necessitates collaborative efforts between state legislatures, health systems, and providers.
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Affiliation(s)
- Nikhil R Shah
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
| | - Anthony Price
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Keyan Mobli
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Sean O'Leary
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ravi S Radhakrishnan
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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Yau A, Lentskevich MA, Yau I, Reddy NK, Ahmed KS, Gosain AK. Do Unpaid Children's Hospital Account Balances Correlate with Family Income or Insurance Type? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5310. [PMID: 37799440 PMCID: PMC10550046 DOI: 10.1097/gox.0000000000005310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
Background Current understanding of medical debt among various income ranges and insurance carriers is limited. We analyzed median household incomes, insurance carriers, and medical debt of plastic surgery patients at a major metropolitan children's hospital. Methods A retrospective chart review for zip codes, insurance carriers, and account balances was conducted for 2018-2021. All patients were seen by members of the Division of Pediatric Plastic Surgery at Ann and Robert H. Lurie Children's Hospital of Chicago. Blue Cross was reported separately among other commercial insurance carriers by the hospital's business analytics department. Median household income by zip code was obtained. IBM SPSS Statistics was used to perform chi-squared tests to study the distribution of unpaid account balances by income ranges and insurance carriers. Results Of the 6877 patients, 630 had unpaid account balances. Significant differences in unpaid account balances existed among twelve insurance classes (P < 0.001). There were significant differences among unpaid account balances when further examined by median household income ranges for Blue Cross (P < 0.001) and other commercial insurance carriers (P < 0.001). Conclusions Although patients with insurance policies requiring higher out-of-pocket costs (ie, Blue Cross and other commercial insurance carriers) are generally characterized by higher household incomes, these patients were found to have higher unpaid account balances than patients with public insurance policies. This suggests that income alone is not predictive of unpaid medical debt and provides greater appreciation of lower income families who may make a more consistent effort in repaying their medical debt.
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Affiliation(s)
- Alice Yau
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Marina A. Lentskevich
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Irene Yau
- William Beaumont Army Medical Center, El Paso, Tex
| | - Narainsai K. Reddy
- Texas A&M Health Science Center, Engineering Medicine (EnMed), Bryan, Tex
| | - Kaleem S. Ahmed
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Arun K. Gosain
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
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Georgeades C, Young SA, Nataliansyah MM, Van Arendonk KJ. Characterizing rural families' experiences receiving pediatric surgical care: A qualitative study. J Rural Health 2023; 39:833-843. [PMID: 37430387 DOI: 10.1111/jrh.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Access to pediatric surgical care is influenced by multiple factors, including proximity to care and financial resources. There is limited understanding regarding the process by which rural children acquire surgical care. We qualitatively explored rural families' experiences seeking surgical care for their children at a major children's hospital. METHODS Parents or legal guardians ≥18 years of age with children who received general surgical care at a major children's hospital and who lived in rural areas were included. Operative logs from 2020 to 2021 and postoperative clinic visits were used to identify families. Semi-structured interviews explored rural families' experiences receiving surgical care. Interviews were inductively and deductively analyzed to create codes and identify thematic domains. Twelve interviews (with 15 individuals) were conducted before thematic saturation was reached. FINDINGS Children were predominantly White (92%) and lived a median of 98.3 mi (interquartile range 49.4-147.0 mi) from the hospital. Four thematic domains were identified: (1) Accessing surgical care included difficulties with referral processes and travel/lodging burdens; (2) surgical care processes involved treatment details and provider/hospital expertise; (3) resources for navigating care encompassed families' employment status, financial burden, and technology use; and (4) social support included family situations, emotions and stress, and coping with diagnoses. CONCLUSIONS Rural families experienced difficulties with obtaining referrals, challenges with travel and employment, and the benefits of technology use. These findings can be applied to the development of tools that can ease challenges faced by rural families whose children require surgical care.
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Affiliation(s)
- Christina Georgeades
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Staci A Young
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Family and Community Medicine, Center for Healthy Communities and Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mochamad Muska Nataliansyah
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kyle J Van Arendonk
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Georgeades C, Vacek J, Thurm C, Hall M, Rangel S, Minneci PC, Oldham K, Van Arendonk KJ. Association of Rural Residence With Surgical Outcomes Among Infants at US Children's Hospitals. Hosp Pediatr 2023; 13:733-743. [PMID: 37470121 DOI: 10.1542/hpeds.2023-007227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Disparities in pediatric health outcomes are widespread. It is unclear whether rurality negatively impacts outcomes of infants with surgical congenital diseases. This study compared outcomes of rural versus urban infants requiring complex surgical care at children's hospitals in the United States. METHODS Rural and urban infants (aged <1 year) receiving surgical care at children's hospitals from 2016 to 2019 for esophageal atresia, gastroschisis, Hirschsprung's disease, anorectal malformation, and congenital diaphragmatic hernia were compared over a 1-year postoperative period using the Pediatric Health Information System. Generalized linear mixed effects models compared outcomes of rural and urban infants. RESULTS Among 5732 infants, 20.2% lived in rural areas. Rural infants were more frequently white, lived farther from the hospital, and lived in areas with lower median household income compared with urban infants (all P < .001). Rural infants with anorectal malformation and gastroschisis had lower adjusted hospital days over 1 year; rural infants with esophageal atresia had higher adjusted odds of 30-day hospital readmission. Adjusted mortality, hospital days, and readmissions were otherwise similar between the 2 groups. Outcomes remained similar when comparing urban infants to rural infant subgroups with the longest hospital travel distance (≥60 miles) and lowest median household income (<$35 000). CONCLUSIONS Despite longer travel distances and lower financial resources, rural infants with congenital anomalies have similar postoperative outcomes to urban infants when treated at children's hospitals. Future work is needed to examine outcomes for infants treated outside children's hospitals and to determine whether efforts are necessary to increase access to children's hospitals.
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Affiliation(s)
| | - Jonathan Vacek
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Cary Thurm
- Children's Hospital Association, Lenexa, Kansas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Shawn Rangel
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Keith Oldham
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Bustorff-Silva J, Miranda ML, Rosendo A, Gerk A, Oliveira-Filho AG. Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000522. [PMID: 37215247 PMCID: PMC10193071 DOI: 10.1136/wjps-2022-000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil. Methods We collected data on the pediatric surgical workforce, surgical volume, Gross Domestic Product per capita, and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019. Results Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil, corresponding to 1414 pediatric surgeons (some pediatric surgeons are registered in more than one state), or 2.4 pediatric surgeons per 100 000 children 14 years of age and younger. There were 828 men and 586 women. The mean age was 51.5±12.8 years, and the mean time from graduation was 3.4±5.7 years. There is a higher concentration of pediatric surgeons in the wealthier Central-West, South, and Southeast regions. Individual surgical volume ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Of these, only nine (6.1%) were high-complexity (including neonatal) operations. MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil. Conclusions Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status. Regions with an increased surgical workforce were associated with lower MGITM. The average number of complex operations performed annually by each pediatric surgeon was considerably low. Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil. Level of evidence Retrospective review; level IV.
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Affiliation(s)
| | - Marcio Lopes Miranda
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Amanda Rosendo
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Ayla Gerk
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
- Medicine, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
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Bauser-Heaton H, El-Said H, Hijazi ZM, Vincent RN, Zellers TM, Ing FF. Regionalization of Care in Congenital Interventional Cardiology. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100534. [PMID: 39132541 PMCID: PMC11307728 DOI: 10.1016/j.jscai.2022.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 08/13/2024]
Affiliation(s)
| | - Howaida El-Said
- The University of California, San Diego, San Diego, California
| | - Ziyad M. Hijazi
- Weill Cornell Medical, New York, New York
- Sidra Medicine, Doha, Qatar
| | - Robert N. Vincent
- Department of Pediatric Cardiology, Westchester Medical Center, Hartsdale, New York
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Gerdfaramarzi MS, Bazmi S, Kiani M, Afshar L, Fadavi M, Enjoo SA. Ethical challenges of cord blood banks: a scoping review. J Med Life 2022; 15:735-741. [PMID: 35928362 PMCID: PMC9321494 DOI: 10.25122/jml-2021-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Cord blood is a rich source of hematopoietic stem cells used to treat many diseases of blood origin. Thus, storage banks were created to store and provide umbilical cord cells. With the development of diagnostic and therapeutic technologies and techniques in medicine, ethical issues have also become more widespread and complex. After the creation of the cord blood banks, efforts were made to address the ethical issues associated with such banks. The present study attempts to identify the ethical challenges in these banks in the published studies. Databases including PubMed, Scopus, Web of Science (WOS), Embase, Proquest, and Google Scholar were searched from January 1996 to January 2021. Then, the ethical challenges of the cord blood bank were extracted from the results section using thematic content analysis. 22 studies were selected based on inclusion and exclusion criteria. The ethical challenges raised in the studies included private or public ownership of the bank, fair access to banking services, informed and voluntary consent, failure to provide sufficient information to individuals about the process, confidentiality of user's information, conflict of interest of bank founders (who are commonly doctors). The findings of this study indicated that there are serious ethical concerns regarding umbilical cord blood banks. Responding clearly to these ethical challenges calls for the attention of policymakers and medical ethics professionals; this will require a clear statement of the various aspects of these banks for society.
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Affiliation(s)
- Madjid Soltani Gerdfaramarzi
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Bazmi
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrzad Kiani
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Afshar
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Fadavi
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Enjoo
- Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author: Seyed Ali Enjoo, Department of Medical Ethics, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
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Apfeld JC, Wood RJ, Halleran DR, Deans KJ, Minneci PC, Cooper JN. Relationships Between Hospital and Surgeon Operative Volumes and Surgical Outcomes in Hirschsprung's Disease. J Surg Res 2021; 257:379-388. [DOI: 10.1016/j.jss.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/14/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
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