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Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States

  • Allison C. Redpath MahonEmail author
  • Troy Richardson
  • Alicia M. Neu
  • Bradley A. Warady
  • on behalf of the SCOPE Investigators
Original Article
Part of the following topical collections:
  1. What's New in Dialysis

Abstract

Background

Although peritonitis causes significant morbidity and mortality in children receiving chronic peritoneal dialysis (CPD), little is known about costs associated with treatment.

Methods

We analyzed 246 peritonitis-related hospitalizations in the USA, linked by the Standardized Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) and Pediatric Health Information Systems (PHIS) databases. Multivariable logistic regression was used to assess the relationship between high-cost hospitalizations (at or above the 75th percentile) and patient characteristics. Multivariable modeling was used to assess differences in the service-line specific geometric mean between (1) high- and low-cost (below the 75th percentile) hospitalizations and (2) fungal versus other types of peritonitis. Wage-adjusted hospitalization charges were converted to estimated costs using reported cost-to-charge ratios to estimate the cost of hospitalization.

Results

High-cost hospitalizations were associated with the following: age 3–12 years, Hispanic ethnicity, intensive care unit (ICU) stay, length of stay (LOS), and fungal peritonitis. Whereas absolute standardized cost by service line was significantly different when comparing high- and low-cost hospitalizations, the percentage of total cost by service line was similar in the two groups. Cost per case for fungal peritonitis was higher (p < 0.001) in every service line except pharmacy when compared to other peritonitis cases. The median (IQR) cost of hospitalization for the treatment of peritonitis was $13,655 ($7871, $28434) USD.

Conclusions

Hospitalization-related costs for peritonitis treatment are substantial and arise from a variety of service lines. Fungal peritonitis is associated with high-cost hospitalization.

Keywords

Peritoneal dialysis-related infection Cost-to-charge ratio Wage-adjusted charges Service line Pediatric peritonitis Direct cost 

Notes

Compliance with ethical standards

The Institutional Review Board (IRB) at each participating center approved the collaborative protocol and informed consent was obtained where required by the institution’s IRB.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2019

Authors and Affiliations

  1. 1.Division of Pediatric NephrologyUniversity of Wisconsin American Family Children’s HospitalMadisonUSA
  2. 2.Children’s Hospital AssociationLenexaUSA
  3. 3.Division of Pediatric NephrologyJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Division of Pediatric NephrologyChildren’s Mercy Kansas CityKansas CityUSA

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