<< Back to the abstract archive
Cost Analysis of Mandibular Distraction versus Tracheostomy in Neonates with Isolated and Syndromic Tongue-Based Airway Obstruction: A Large Single Center Series
Christopher M. Runyan, MD, PhD, Armando Uribe-Rivera, DDS, Shahryar Tork, MD, Audrey Karlea, MSc, Jareen Meinzen-Derr, PhD, Dawn Rothchild, MSN, RN, PCNS-BC, Jay Paul Willging MD, Evan J. Propst, MD,
Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2013-03-14
Presenter: Shahryar Tork
Affidavit:
I am a PGY2 general surgery resident at Good Samaritan Hospital, a community program in Cincinnati, Ohio. I am involved in research with the plastic surgery division at Cincinnati Children's Hospital. As a member of a team investigating Pierre Robin Sequence, my involvement includes literature review, patient chart extraction, data collection, data synthesis & analysis, and writing contributions.
Director Name: Kevin J. Grannan, MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Tongue-based airway obstruction (TBAO), commonly due to Pierre Robin sequence, can be an urgent problem for neonates. Severe cases of TBAO require surgical intervention, namely tracheostomy or mandibular distraction. Both approaches have distinct advantages, and controversy exists over which to use. One important consideration is the financial costs of the two methods.
Purpose: This study compares the costs associated with tracheostomy, versus mandibular distraction, for treatment of neonates with TBAO.
Methods: With IRB-approval, we retrospectively studied neonates with TBAO treated from 2001 to 2009 using either tracheostomy (Trach), mandibular distraction (MD), or Trach with subsequent MD (Trach+MD). Actual charges over a 3-year period associated with operative costs, hospital stay, imaging and sleep studies, clinic visits, and related Emergency Room visits were collected. Charges were compared using regression and appropriate statistical analyses.
Results: Forty-seven neonates were included in the study (MD:n=26, Trach:n=12, Trach+MD:n=9). Trach-group patients had 2.6-fold higher charges than the MD group despite no difference in length of ICU-stay. This difference increased to 7.3-fold when including home trach care-related costs. Trach+MD-group patients had longer ICU-lengths of stay and higher OR-fees, but lesser total charges than the Trach-group.
Conclusions: For patients with severe TBAO, mandibular distraction provides significant cost savings over tracheostomy ($300,000 per patient). Increased costs associated with tracheostomy include a higher level of ICU-acuity, need for serial airway procedures, and home trach care costs. Patients with TBAO treated with tracheostomy and subsequent MD may also experience cost savings, because of decreased ICU-acuity and greater likelihood of decannulation.
