A national study to evaluate trends in the utilization of nerve reconstruction for treatment of neonatal XXXX [outcomes article].

@entity1 @entity5300
BACKGROUND: Approximately 4 to 34 percent of @entity1 born with neonatal @entity5300 do not recover spontaneously and require surgery. Despite the increasing availability of microsurgical nerve repair, the authors hypothesize that this condition remains undertreated and that uninsured @entity1 and @entity1 with public insurance are less likely to receive treatment than those with private insurance. METHODS: The authors used a national sample of inpatient hospital discharge data from the Healthcare Cost and Utilization Kids Inpatient Databases for the years 1997, 2000, 2003, and 2006. Relevant discharges were identified using the International Classification of Diseases, Ninth Revision diagnosis code 767.6 for neonatal @entity5300 and procedure codes relating to nerve surgery. Weighted frequencies were calculated to generate national estimates for neonatal @entity5300 births and nerve surgery procedures for these @entity1 . RESULTS: A total of 21,758 births with neonatal @entity5300 and 721 admissions for nerve surgery were identified. Over time, utilization of nerve surgery procedures has generally increased (1.1 percent in 1997 to 3.2 percent in 2006). Treatment with nerve surgery varied significantly according to insurance status-3.8 percent among private insurance discharges, 2.9 percent among Medicaid insurance discharges, and 0.7 percent among self-pay/uninsured records (p < 0.001). The mean age among nerve surgery @entity1 was 235    75 days, and the mean total charges associated with microsurgical intervention was  24,534     30,460. CONCLUSIONS: Over the past decade, approximately 3.3 percent of neonatal @entity5300 births have undergone some form of primary microsurgical nerve surgical intervention, which may reflect underutilization of these procedures and limited access to care. Insurance status plays a significant role in the use of nerve surgery procedures, as neonates without private insurance were less likely to receive nerve surgery procedures than those with private insurance.
