|
||
Otolaryngology, ENT & Sinus News Provided by the California Sinus CentersLack of Financial Barriers to Pediatric Cochlear Implantation: Impact of Socioeconomic Status on Access and Outcomes [Original Article]July 1, 2010, 12:00 pm by Archives of Otolaryngology Head & Neck SurgeryObjectives (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation. Design Retrospective cohort study. Setting University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio. Participants Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008. Main Outcome Measures Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation. Results A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients. Conclusions In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.
More from Archives of Otolaryngology Head & Neck Surgery Professional Burnout Among Microvascular and Reconstructive Free-Flap Head and Neck Surgeons in the United States [Original Article] Archives of Otolaryngology Head & Neck Surgery: August 16, 2010, 12:00 pm Objectives To determine the prevalence of professional burnout among microvascular free-flap (MVFF) head and neck surgeons and to identify modifiable risk factors with the intent to reduce MVFF surgeon burnout.Design A cross-sectional, Iguazu Falls [About the Cover] Archives of Otolaryngology Head & Neck Surgery: August 1, 2010, 12:00 pm About This Journal [About This Journal] Archives of Otolaryngology Head & Neck Surgery: August 1, 2010, 12:00 pm The Learning Curve of Sialendoscopy With Modular Sialendoscopes: A Single Surgeon's Experience [Original Article] Archives of Otolaryngology Head & Neck Surgery: August 1, 2010, 12:00 pm Objective To assess the learning curve of sialendoscopy with modular endoscopes based on operative parameters and a postoperative performance rating. Design Prospective study, case series. Setting Tertiary referral hospital. Patients The study included 50 consecutive Dexamethasone Administration and Postoperative Bleeding Risk in Children Undergoing Tonsillectomy [Original Article] Archives of Otolaryngology Head & Neck Surgery: August 1, 2010, 12:00 pm Objective To assess whether administration of dexamethasone during tonsillectomy is associated with a dose-dependent increased rate of postoperative tonsillectomy hemorrhage. Design Retrospective review of 2788 children and adolescents who underwent tonsillectomy with or
|
