The Public Health Burden of Lymphatic Malformations in Children: National Estimates in the United States, 2000-2009

Jeffrey Cheng, Beiyu Liu, Alfredo E Farjat, Jonathan Routh, Jeffrey Cheng, Beiyu Liu, Alfredo E Farjat, Jonathan Routh

Abstract

Objective: Describe inpatient resource utilization trends in children with lymphatic malformations using a national database.

Data source: Kids' inpatient database, years 2000-2009.

Methods: Subjects included children 18 years and under with International Classification of Diseases (ICD), 9th revision code: 228.1-lymphangioma, any site. Data elements were extracted and used to calculate related inpatient costs and trended over time.

Results: No significant increase in admission rates was noted over time, p = 0.5128. Average total charges per admission were $30,995. There is a clear and increasing trend of total charges per admission; even when adjusted for inflation, this has increased disproportionately. In 2009, the mortality rate increased to 2.58%, which was significantly higher than in previous years, p = 0.0346. In multivariate analysis for mortality, the only factor that was noted to be significant was between survey years 2000 and 2009. The odds ratio (OR) for mortality was 2.97, 95% CI: [1.423-6.202], which indicated that there was an almost three times higher likelihood of mortality in 2009 than in 2000.

Conclusions: Admission rates appear to remain stable for pediatric inpatients with lymphatic malformations but resource utilization related to charges has been increasing from 2000 to 2009. Controlling for inflation does not explain our observed trend in total charge increases. Previously, surgical resection was the most commonly performed procedure, and now the trend has shifted away from operative intervention. Mortality rates, while low, experienced a rise in 2009. Further investigation may be warranted.

Keywords: HCUP; KID database; costs; lymphangioma; lymphatic malformation; resource utilization; sclerotherapy.