Determinants of Hospital Charges in Pediatric Cleft Palate Repair: A National Survey-Weighted Analysis

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Understanding financial drivers of cleft palate repair (CPR) cost is increasingly relevant in value-based surgical care. Variation in hospital charges for CPR also remains poorly understood. The 2022 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) was analyzed to evaluate whether insurance type independently influences adjusted hospital charges for CPR. Methods: A cross-sectional analysis of the 2022 HCUP Kids’ Inpatient Database was performed using STATA SE statistical software. Pediatric CPR discharges (n=172; analytic n=170) were identified using ICD-10-CM diagnosis codes Q35.x and ICD-10-PCS procedure codes corresponding to palate repair (e.g., 0CQ0xZZ, 0CQ1xZZ, 0CQ2xZZ). A survey-weighted multivariable linear regression of log-transformed total charges was conducted using discharge weights, stratification, and hospital clustering. Covariates included insurance type, All Patient Refined Diagnosis Related Groups (APR-DRG) severity category (eg. Minor, Moderate, Major/Extreme), age, sex, hospital region, bed size, urbanicity and teaching status (composite variable), and sponsorship. Results: The analytic cohort included 172 unweighted discharges, representing an estimated 234 nationally. The mean total charges were $75,182 (95% CI, $41,289–$109,074; nominal 2022 USD). The adjusted model demonstrated significant overall explanatory capacity (F(16,48)=13.50, p< 0.001; R2=0.312). After controlling for insurance type and hospital structural characteristics, higher severity classification remained strongly and independently associated with greater financial burden. Compared with Minor severity, Major/Extreme severity was associated with a 1.108 increase in log charges (p< 0.001), corresponding to an approximate 3-fold increase in total charges. Insurance type was not found to be independently associated with charges (all p>0.10). Hospital urbanicity and teaching status was independently associated with increased charges. Compared with rural teaching hospitals, urban teaching hospitals were associated with a 71% increase in adjusted total charges (β=0.537, p< 0.001). However, interpretation is limited by the small number of rural hospitals represented in the analytic cohort. Conclusion: In a nationally representative pediatric cohort, financial variation in cleft palate repair charges is primarily driven by clinical severity and hospital characteristics rather than a patient’s insurance type. Future multi-year analyses are warranted to confirm payer neutrality and assess cost-adjusted outcomes.

Volume

14

Issue

Suppl 4

First Page

7

Last Page

8

Comments

Michigan Academy of Plastic Surgeons 34th Biennial Scientific Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276696.20292.07

ISSN

2169-7574

Link to Full Text

Share

COinS