A Novel Outcomes Calculator for VACTERL Association in Neonates

Author: Aditya Mantha

Purpose: To create an easy-to-use, robust and dynamic clinical tool to enable providers and families to understand the likelihood of finding anomalies in the workup of neonates suspected to have VACTERL association.  Once the diagnosis of VACTERL has been established, the patient’s clinical course likelihood of key outcomes, based on birthweight and the unique composition of anomalies identified, can be estimated. Methods: Employing the Kid’s Inpatient Database (KID), neonates (<29 days old) with VACTERL were identified using ICD-9 codes. Multivariable logistic regression was used to estimate inpatient mortality, and Poisson regression to estimate GDP-adjusted cost, length-of-stay and number of procedures during initial hospitalization.  This was calculated for each combination of VACTERL anomalies and modified by birthweight, gender and race. Results: 2843 of 11,813,782 neonatal patients presented with VACTERL in the 2003, 2006, 2009, and 2012 KID Databases. The mean length of stay was 30.3 days (95% CI: 28.4 - 32.1) and the mean cost at discharge was $84,378 (95% CI: $77,334 - $91,422).  344 (12.1%) patients died during hospitalization and were more likely to have tracheoesophageal fistula (p < 0.05), limb abnormality (p < 0.01) and weight less than 1750 g (p < 0.001).  Race, gender and insurance were not significantly associated with these outcomes. Conclusions: We present the creation of a neonatal VACTERL association calculator—accessible athttps://pedsurg.shinyapps.io/vacterl—that enables providers to estimate likelihood of additional VACTERL anomalies and family members to estimate the presence of anomalies, clinical course of disease and cost of care.  

Co Author/Co-Investigator Names/Professional Title: Mantha A (1) MS, Delaplain PJ (1) MD, Guner YS (2) MD,Yu PT (2) MD 1. Department of Surgery, University of California Irvine School of Medicine, California 2. 2. Department of Pediatric Surgery, CHOC Children’s Hospital, Orange, California