Vijaya Kancherla1, Chen Ma2, Gerald Grant3, Henry C Lee2, Gary M Shaw2, Susan R Hintz2, Suzan L Carmichael2. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 2. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California. 3. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
Abstract
OBJECTIVE: To examine factors associated with timely (0-2 days after birth) myelomeningocele surgical repair. STUDY DESIGN: We examined 2006 to 2011 births from the California Perinatal Quality Care Collaborative, linking to hospital discharge and vital records. Selected maternal, infant, and delivery hospital characteristics were evaluated to understand disparities in timely repair. Poisson regression was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). RESULTS: Overall, 399 of the 450 (89%) infants had a timely repair and approximately 80% of them were delivered in level III/IV hospitals. Infants with hydrocephalus were significantly less likely to have a delayed myelomeningocele repair compared with those without (aRR = 0.22; 95% CI = 0.13, 0.39); infants whose medical care was paid by Medi-Cal or other nonprivate insurance were 2.2 times more likely to have a delayed repair compared with those covered by a private insurance (aRR = 2.23; 95% CI = 1.17, 4.27). Low birth weight was a significant predictor for delayed repair (aRR = 2.06; 95% CI = 1.10, 3.83). CONCLUSION: There was a significant disparity in myelomenigocele repair based on medical care payer. Families and hospitals should work together for timely repair in hospitals having specialized multidisciplinary teams. Findings from the study can be used to follow best clinical practices for myelomeningocele repair. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: To examine factors associated with timely (0-2 days after birth) myelomeningocele surgical repair. STUDY DESIGN: We examined 2006 to 2011 births from the California Perinatal Quality Care Collaborative, linking to hospital discharge and vital records. Selected maternal, infant, and delivery hospital characteristics were evaluated to understand disparities in timely repair. Poisson regression was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). RESULTS: Overall, 399 of the 450 (89%) infants had a timely repair and approximately 80% of them were delivered in level III/IV hospitals. Infants with hydrocephalus were significantly less likely to have a delayed myelomeningocele repair compared with those without (aRR = 0.22; 95% CI = 0.13, 0.39); infants whose medical care was paid by Medi-Cal or other nonprivate insurance were 2.2 times more likely to have a delayed repair compared with those covered by a private insurance (aRR = 2.23; 95% CI = 1.17, 4.27). Low birth weight was a significant predictor for delayed repair (aRR = 2.06; 95% CI = 1.10, 3.83). CONCLUSION: There was a significant disparity in myelomenigocele repair based on medical care payer. Families and hospitals should work together for timely repair in hospitals having specialized multidisciplinary teams. Findings from the study can be used to follow best clinical practices for myelomeningocele repair. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Vijaya Kancherla; Chen Ma; Gerald Grant; Henry C Lee; Susan R Hintz; Suzan L Carmichael Journal: Am J Perinatol Date: 2020-05-30 Impact factor: 1.862
Authors: Neha J Purkey; Chen Ma; Henry C Lee; Susan R Hintz; Gary M Shaw; Doff B McElhinney; Suzan L Carmichael Journal: Pediatr Cardiol Date: 2021-02-03 Impact factor: 1.838