Financial Impact of Surgical Care for Scoliosis, Developmental Hip Dysplasia, and Slipped Capital Femoral Epiphysis in Children

Background: While pediatric musculoskeletal (MSK) conditions contribute to the global burden of disease, national estimates of their prevalence and costs as well as the impact of surgery are virtually non-existent, particularly for non-trauma related conditions.  In this paper, we provide national estimates of surgery frequency and hospital costs as well as identify gaps in our understanding of the financial impact of three non-trauma related pediatric MSK conditions: scoliosis, developmental hip dysplasia (DDH), and slipped capital femoral epiphysis (SCFE).  Method: The 2012 Kids’ Inpatient Database (KIDs), select State Ambulatory Surgery and Services Database (SASD), and U.S. Census Bureau data were used to estimate utilization, hospital costs, and separate inpatient and outpatient procedural volume. Charges were converted to costs using cost-to-charge ratios provided by KIDs and the Centers for Medicare & Medicaid Services. A literature review was performed on the indirect costs associated with these conditions. Results: In 2012, U.S. annual surgical procedure estimates were 9,607 for scoliosis, 2,554 for DDH, and 2,464 for SCFE. Inpatient surgery was more common for each of these conditions, with 94% of scoliosis, 73% of DDH, and 62% of SCFE surgeries performed in the inpatient hospital setting. Total annual hospital costs for the three surgeries were almost $400 million (2012 USD), with scoliosis surgery accounting for 91 percent of these costs. The literature review demonstrated an association between these conditions and long-term social health outcomes, but studies have not analyzed the long-term economic effects of these conditions. Conclusion: Hospital costs related to surgery for scoliosis, DDH, and SCFE are significant but likely represent only a fraction of the full societal costs of these conditions, particularly if left untreated. Surgery has the potential to reduce the societal burden of these conditions through reduced disability and greater productivity. While we can document the cost to treat pediatric MSK conditions; more research is needed to fully appreciate what the financial burden would have been for the natural history of these conditions. Key Concepts: National estimates of the prevalence and costs of pediatric musculoskeletal conditions and the impact of surgery are virtually non-existent, particularly for non-trauma related conditions. In 2012, U.S. annual surgical procedure estimates were 9,607 for scoliosis, 2,554 for DDH, and 2,464 for SCFE. Hospital costs related to surgery for scoliosis, DDH, and SCFE are significant but likely represent only a fraction of the full societal costs of these conditions. There are challenges with obtaining data on pediatric musculoskeletal conditions and measuring their long-term financial impact on patients and society.