Danis David O'Neil, Zaccardelli Alessandra, Singla Arnav K, Meyer Aiden, Scott Andrew R
From the Dr. Elie E. Rebeiz Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA.
Department of Otolaryngology, Tufts University School of Medicine, Boston, MA.
Plast Reconstr Surg Glob Open. 2025 Feb 14;13(2):e6550. doi: 10.1097/GOX.0000000000006550. eCollection 2025 Feb.
Robin sequence is an anomaly of micrognathia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) performed in early infancy relieves airway obstruction and improves feeding difficulties. Though clinical outcomes data for MDO are strong, studies examining the cost drivers of the procedure are scarce.
A retrospective 10-year single-institution chart review examined medical and billing records of infants undergoing MDO at an urban tertiary care center. Data included hospital charges, patient characteristics, comorbidities/complications, intubation duration, and length of stay (LOS). Multivariate regression analysis determined significant cost contributors over the course of admission. Conclusions from this smaller sample were compared with analyses from a larger, less detailed, population-based inpatient registry using the Kids' Inpatient Database (2016 and 2019).
In the single-institution analysis, 29 cases were identified with a mean age of 12 days at hospital admission. Mean postoperative and overall LOS were 19 ± 10 and 31 ± 13 days, respectively. Mean total charges were $287K-$118K. The most significant driver of total charges was floor charges ( < 0.01). LOS was a proxy for floor charges, as they were highly correlated ( = 0.98). LOS was significantly driven by intubation duration ( = 0.01). In the nationwide analysis, 165 weighted cases were identified; mean age was 2 months at hospital admission. Mechanical ventilation >96 hours was associated with increased LOS and hospitalization costs.
Of infants with Robin sequence undergoing MDO, the most significant driver of total charges was LOS. Intubation duration was highly associated with LOS.
罗宾序列征是一种包括小下颌、舌后坠和气道阻塞的先天性畸形。婴儿早期进行下颌骨牵引成骨术（MDO）可缓解气道阻塞并改善喂养困难。尽管MDO的临床疗效数据很充分，但研究该手术成本驱动因素的研究却很少。
一项为期10年的单机构回顾性图表审查，检查了一家城市三级医疗中心接受MDO的婴儿的医疗和计费记录。数据包括医院收费、患者特征、合并症/并发症、插管持续时间和住院时间（LOS）。多变量回归分析确定了入院期间的主要成本因素。将这个较小样本的结论与使用儿童住院数据库（2016年和2019年）进行的更大规模、细节较少的基于人群的住院登记分析结果进行了比较。
在单机构分析中，共识别出29例病例，入院时平均年龄为12天。术后平均住院时间和总住院时间分别为19±10天和31±13天。平均总费用为28.7万美元至11.8万美元。总费用的最重要驱动因素是病房费用（P<0.01）。住院时间是病房费用的一个替代指标，因为它们高度相关（r=0.98）。住院时间受插管持续时间的显著影响（P=0.01）。在全国性分析中，识别出165例加权病例；入院时平均年龄为2个月。机械通气>96小时与住院时间延长和住院费用增加相关。
在接受MDO的罗宾序列征婴儿中，总费用的最重要驱动因素是住院时间。插管持续时间与住院时间高度相关。
