# Increasing surgical healthcare utilization for infants with congenital anomalies in Texas

## TL;DR

This study shows that infants with congenital anomalies in Texas account for a large share of surgical healthcare costs, with costs rising as more organ systems are affected.

## Contribution

The study quantifies the financial impact of surgical care for infants with congenital anomalies in Texas.

## Key findings

- CA-surgical admissions accounted for 73.3% of surgical charges despite being a minority of admissions.
- Median charges increased with the number of affected organ systems, reaching $25,313 for four or more systems.
- Infants with more complex CAs had higher rates of surgical admissions and higher costs.

## Abstract

Congenital anomalies (CAs) impact 3% of live births and account for disproportionately high healthcare costs. While many CAs require multidisciplinary care and surgical intervention, the overall financial impact of infants diagnosed with CA with surgical needs is unknown. We aim to evaluate and characterize the charges of care in infants with CA and surgical needs in Texas.

A database study using the Texas Inpatient Public Use Data File was performed to query infants (<365 days) statewide from 1/2021 to 12/2021 for admissions with CA and involved organ system by ICD-10 codes. Encounters transferred to an outside hospital were excluded to avoid systematic double-counting. Descriptive statistics were performed.

Of 376,215 total admissions, 81,666 had surgical needs with OR charges. While non-CA represent the majority of surgical admissions (63,895/81,666; 78.24%), CA-surgical admissions represent 73.3% ($4.766/$6.496 billion) surgical admissions charges. Of CA-surgical admissions, 78.9% were single organ-system (1CA) with 14.5% with two organ-systems (2CA), 4.0% with three organ-system (3CA) and 2.6% with 4 + organ-systems (4 + CA). The proportion of admissions with surgical needs increases with the number of CA organ-systems involved. The median charge per CA-surgical admission was $1,296 for1CA, $4,517 for 2CA, $20,272 for 3 CA, and $25,313 for 4 + CA compared to the $797 for non-CA surgical admissions. Surgical admission charges increase with the number of CA organ-systems involved.

Surgical care of CA in infants is associated with significant healthcare utilization, accounting for $4.8 billion (73.4%) of all inpatient charges in 2021 despite representing a minority of admissions. Increasing number of CA organ-systems involved is associated with an increased proportion of patients with surgical admissions and increased median charge of admission.