Belcher Ryan H, Patel Kalpana, Goudy Steven, Gelbard Alexander, Hatch L Dupree, Morris Emily A, Golinko Michael, Phillips James D, Scott Andrew
Vanderbilt Division of Pediatric Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A.
Vanderbilt Cleft and Craniofacial Team, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A.
Laryngoscope. 2025 Mar;135(3):1192-1198. doi: 10.1002/lary.31810. Epub 2024 Oct 3.
OBJECTIVES/HYPOTHESIS: To evaluate costs associated with perioperative gastrostomy tube (G-tube) placement for neonates with Robin sequence (PRS) that undergo mandibular distraction osteogenesis (MDO).
Retrospective chart review was performed to examine the medical records of neonates with RS who received treatment at our institution between 2012 and 2021. Patients under 6 months of age that underwent MDO for RS were included. Billing records of hospital costs over a 2-year period were analyzed.
The study included 26 total patients with 11 in the MDO-only group, 9 in G-tube after MDO group, and 6 in G-tube before MDO group. There was a significant difference (p < 0.001) in total hospital costs between groups with MDO-only group averaging $119,532 (SD 33,503), the G-tube after MDO group averaging $245,315 (SD 102,327), and G-tube before MDO group averaging $252,300 (SD 84,990). Multiple linear regression was performed controlling for genetic syndrome and birth weight, which still showed a statistically significant difference in total cost between the MDO-only group and G-tube after MDO (p = 0.006), and between the MDO-only group and G-tube prior to MDO (p = 0.01). There was a significant difference in costs between all three groups for total inpatient/outpatient costs with MDO-only group averaging $78,502 (SD 30,953), the G-tube after MDO group averaging $176,125 (SD 84,315), and the G-tube prior to MDO group averaging $156,309 (SD 95,746).
MDO performed without perioperative G-tube placement may reduce charges by >$100,000. The associated improvement of dysphagia after MDO surgery and potential for avoiding a G-tube has tremendous downstream cost and social benefits for families.
NA Laryngoscope, 135:1192-1198, 2025.
目的/假设：评估接受下颌骨牵引成骨术（MDO）的罗宾序列征（PRS）新生儿围手术期放置胃造口管（G管）的相关成本。
进行回顾性病历审查，以检查2012年至2021年期间在本机构接受治疗的RS新生儿的病历。纳入6个月以下因RS接受MDO的患者。分析了两年期间的医院费用计费记录。
该研究共纳入26例患者，仅行MDO组11例，MDO后放置G管组9例，MDO前放置G管组6例。各组之间的总住院费用存在显著差异（p<0.001），仅行MDO组平均为119,532美元（标准差33,503），MDO后放置G管组平均为245,315美元（标准差102,327），MDO前放置G管组平均为252,300美元（标准差84,990）。进行了多元线性回归，对遗传综合征和出生体重进行了控制，结果显示仅行MDO组与MDO后放置G管组之间的总成本仍存在统计学显著差异（p=0.006），仅行MDO组与MDO前放置G管组之间也存在统计学显著差异（p=0.01）。三组之间的总住院/门诊费用存在显著差异，仅行MDO组平均为78,502美元（标准差30,953），MDO后放置G管组平均为176,125美元（标准差84,315），MDO前放置G管组平均为156,309美元（标准差95,746）。
围手术期不放置G管进行MDO可能会减少超过10万美元的费用。MDO手术后吞咽困难的相关改善以及避免放置G管的可能性对家庭具有巨大的下游成本和社会效益。
NA《喉镜》，135:1192 - 1198，2025年。
