Making the Business Case for Quality and Safety.

There is broad understanding and appreciation that quality and safety are indispensable parts of the business enterprise of delivering care. However, because health care organizations have resource constraints and competing priorities, leaders and managers must create, demonstrate, and articulate a business case for continuing to prioritize investments in quality and safety. To accomplish this, one must leverage financial principles with compelling story-telling. Success creates a virtuous cycle whereby ongoing investments in robust structures increase returns (value defined as improvements in quality and safety outcomes), and cost savings are reinvested to continue to improve delivery of high-quality care.

Resource utilization and national demographics of laryngotracheal trauma in children.

IMPORTANCE: Pediatric laryngotracheal trauma is rare but can carry considerable morbidity and health care resource expenditure. However, the true cost of these injuries has not been thoroughly investigated. OBJECTIVE: To use a national administrative pediatric database to identify normative data on pediatric laryngotracheal trauma, specifically with regard to cost and resource utilization. DESIGN AND PARTICIPANTS: Retrospective medical record review using the Kids' Inpatient Database (KID) 2009. Inclusion criteria were admissions with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for fractures or open wounds of the larynx and trachea. MAIN OUTCOMES AND MEASURES: Among many data analyzed were demographic information and admission characteristics, including length of stay, diagnoses, procedures performed, and total charges. RESULTS: There were 106 admissions that met inclusion criteria. Patient mean (SE) age was 15.9 (0.45) years, and 79% were males. The mean (SE) length of stay (LOS) was 8.4 (1.1) days; more than 50% of patients had a LOS longer than 4 days. The mean number of diagnoses per patient was 6.9 (0.6); other traumatic injuries included pneumothorax (n = 18). More than 75% of patients underwent more than 2 procedures during their admission; 60.2% underwent a major operative procedure. The most common procedures performed were laryngoscopy (n = 54) and operative repair of the larynx and/or trachea (n = 32). Tracheostomy was performed in only 30 patients. The mean (SE) total charge was $90,879 ($11,419), and one-third of patients had total charges more than $100,000. CONCLUSIONS AND RELEVANCE: Pediatric laryngotracheal trauma remains a relatively rare clinical entity. These injuries primarily affect older children and are associated with long hospitalizations, multiple procedures, and high resource utilization.

Socioeconomic implications of pediatric cervical methicillin-resistant Staphylococcus aureus infections.

OBJECTIVE: To study cervical methicillin-resistant Staphylococcus aureus (MRSA) infections using a national database with the goal of providing normative data and identifying variations in resource utilization. DESIGN: Retrospective review using a pediatric national data set (Kids' Inpatient Database 2009). SUBJECTS: Inclusion criteria were admissions with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for both MRSA and specific neck and pharyngeal infections. RESULTS: There were 26,829 admissions with MRSA; 3571 included a head and neck infection. The mean (SE) age at admission was 7.72 (0.20) years. Most patients (65.0%) were in the lower 2 socioeconomic quartiles; the most common payer was Medicaid (53.3%). The mean total charge per admission was $20,442. The mean (SE) length of stay (LOS) was 4.39 (0.15) days; there were significant differences among age (P < .001) and racial (P < .001) groups. A total of 1671 children underwent at least 1 surgical drainage procedure; there were statistically significant differences among racial (P < .001), age (P < .001), and socioeconomic (P = .048) groups. There were no regional variations in resource utilization when LOS, number of procedures, and total hospital charges were compared. CONCLUSIONS: Cervical MRSA infections have a large socioeconomic impact across the nation. There are differences among the various races in resource utilization. Younger children have longer hospitalizations, are more likely to need surgery, and require more intubations. Children from the lowest socioeconomic group require surgery more frequently, but their LOS is not statistically different when compared with the other 3 groups. Knowledge of such characteristics for cervical MRSA infections in children can facilitate targeted clinical interventions to improve care of affected populations.

Healthcare cost usage for hospitalised injuries sustained in industrial settings in the USA.

OBJECTIVE: To describe characteristics and outcomes of patients hospitalised for injuries occurring in industrial settings during a 1-year period. METHODS: A retrospective analysis of hospital admissions in the USA in 2006 using the Nationwide Inpatient Sample was performed. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises) was used to identify work-related injury admissions. RESULTS: A total of 5826 patients were hospitalised with injuries sustained in industrial settings (weighted, 28,354 patients). The mean age was 42.9 years (82% were men). They were 48% Caucasian, 19% Hispanic and 6% African-American. The majority were admitted from the Emergency Department (72%). Further the majority of admissions were discharged home (79%; 9% with home healthcare) and 10.7% were transferred to another facility. The mean length of stay was 4.5 days (range 0-109 days). Mean total charges per admission was US$32,254 (median US$18,364, 90th percentile US$66,607). Common diagnoses included: orthopaedic injuries (including amputations) to: finger/hand (20.9%), foot/ankle (8.2%), leg (10.2%) and spine (8.4%); infection (10.8%), pulmonary diagnosis (6.6%), soft tissue injuries (3.6%) and burns to <10% of the body (3.6%). Comorbidities included hypertension (17.0%) and diabetes mellitus (6.3%). Most common procedures performed included fracture reduction (17.6%), blood transfusions (3.1%) and spinal surgery (3%). A total of 194 (0.7%) patients died in the hospital. CONCLUSIONS: Injuries in industrial settings result in significant healthcare usage, morbidity and mortality on an annual basis in the USA. These admission levels facilitate development of targeted strategies to optimise the quality and economics of care for injuries in industrial settings.

Thyroidectomy outcomes: a national perspective.

OBJECTIVES: Describe trends and outcomes of patients undergoing thyroidectomy. STUDY DESIGN AND SETTING: Retrospective search of national inpatient database. SUBJECTS AND METHODS: The Nationwide Inpatient Sample 2009 was searched using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for thyroidectomy. Data extraction included patient demographics, hospital characteristics, and associated diagnoses. Subgroup analysis was performed on mortalities; bivariate and multivariate analysis was used to examine predictors of complications. RESULTS: In the United States, 59,478 patients were admitted and underwent thyroidectomy in 2009. Their mean (SD) age was 53.0 (16.4) years. Mean (SD) length of stay was 3.0 (6.9) days, and mean (SD) total charges was $39,236 ($73,679). Total thyroidectomy was performed in 53.6% of patients; 33.2% underwent unilateral lobectomy. Most common thyroid disorders included nontoxic nodular goiter (36.0%) and malignant neoplasm (30.3%). There were 363 (0.61%) mortalities, with a mean (SD) age of 65.5 (15.2) years, length of stay of 13.9 (15.2) days, and total charges of $218,855 ($191,977). Of all patients, 6.18% had hypocalcemia and 0.77% had hypoparathyroidism; the incidence of vocal cord paresis was 0.85% unilaterally and 0.34% bilaterally. Multivariate analysis revealed predictors of complications following thyroid surgery were female sex (P = .0001), total thyroidectomy procedure (P < .0001), hospital location and teaching status (P = .0060), hospital bed size (P = .0054), type of thyroid disorder, and underlying patient comorbidities. CONCLUSION: Reporting of normative data for thyroidectomy facilitates comparison. Hospitalizations for patients undergoing thyroidectomy require significant resource utilization. Predictors of complications include female sex, type of thyroid disorder and procedure, hospital location and teaching status, hospital bed size, and patient comorbidities.

Orbital and periorbital infections: a national perspective.

OBJECTIVES: To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery. DESIGN: Analysis of the Kids' Inpatient Database. SETTING: Administrative data set. PATIENTS: Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis. MAIN OUTCOME MEASURES: Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression. RESULTS: A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P < .001). Surgical patients had a significantly longer mean hospital stay (7.1 vs 3.4 days, P < .001) and a higher mean cost of care ($41 009 vs $13 008, P < .001) compared with nonsurgical patients. Demographic predictors of surgical intervention included male sex, admitting characteristics, and hospital location. Except for sex, these variables remained significant in a multivariate model. Clinically, diplopia is a predictor of surgical intervention (odds ratio, 6.3; 95% confidence interval, 3.4-11.7). CONCLUSIONS: This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.

Variation in surgical time-out and site marking within pediatric otolaryngology.

OBJECTIVE: To determine variation in surgical time-out and site-marking within pediatric otolaryngology. DESIGN: Survey e-mailed via the American Society of Pediatric Otolaryngology (ASPO). PARTICIPANTS: A total of 167 Children's Hospital Corp of America (CHCA) operating room (OR) directors and ASPO members were asked about perioperative preparation of their patients. RESULTS: Most respondents who operate at children's hospitals report policies that do not require site marking for bilateral placement of ventilation tubes, adenotonsillar surgery, airway endoscopy, or nasal surgery. Policies allowing assistants to perform site marking were identified by 45.0% of respondents from children's hospitals. Community hospitals were 3.68 times (range, 1.31-10.31 times) more likely than other facilities to permit only the attending to perform site marking. Most respondents operating at children's hospitals (84.4%) were satisfied with their hospital's site-marking policy and with their hospital's surgical checklist policy for pediatric otolaryngology procedures (87.1%). There seems to be a relationship between ear tube insertion marking policy and surgeon's age (χ² = 12.9; P = .045), area of country (χ² = 29.1; P = .004), and ambulatory centers for children (χ² = 8.1; P = .02). Twenty-one percent of survey respondents reported involvement in a wrong-site surgery at some point in their career. CONCLUSIONS: This survey of ASPO members and CHCA OR directors reveals substantial variation in the time-out and site-marking procedures. There is a dynamic tension between universal, national mandates, and allowing local variation to encourage hospitals to tailor policies to unique needs. Further study is needed to determine if the observed variations are beneficial or harmful.

Pediatric acute sinusitis: predictors of increased resource utilization.

OBJECTIVE: To determine variations in resource utilization in the management of pediatric acute sinusitis. STUDY DESIGN: Retrospective analysis of a publicly available national dataset. METHODS: The Kids' Inpatient Database 2006 was analyzed using ICD-9 codes for acute sinusitis. RESULTS: A total of 8,381 patients (55% male, mean age 8.5 years [SE = 0.2]) were admitted with acute sinusitis. Mean total charges was $20,062 (SE = 1,159.1). Mean length of stay was 4.2 days (SE = 0.12), with 4.8 diagnoses (SE = 0.06) and 0.85 procedures (SE = 0.06). Thirty-six percent had concomitant respiratory diseases, 11% otitis media, and 8% orbital symptoms. A total of 703 patients underwent operations on the upper aerodigestive tract (534 were nasal sinusectomies); 582 patients underwent lumbar puncture and 162 underwent orbital surgery. The primary payer was private insurance in 50% and Medicaid in 41%. Predictors of increased total charges were male gender (P =.028), being a teaching hospital (P < .0001), metropolitan patient location (P < .0001), hospitals in the western region (P < .0001), admission source from another hospital (P < .0001), and discharge status to another inpatient hospital or home healthcare (P < .0001). There is a large geographic variation in resource utilization (range = $5,837 [Arkansas] to $48,327 [California]). Race, primary payer, admission type, and urgency were not significant predictors of increased resource utilization. CONCLUSIONS: Despite being a common diagnosis, there exists a large national variation in management of acute pediatric sinusitis. Predictors of increased resource utilization included male gender, teaching hospital status, metropolitan patient location, western hospital region, admission source, and discharge status. Knowledge of these variables may allow interventions and potentially facilitate benchmarking to reduce the economic burden of this entity while ensuring optimal outcomes.

Wrong-site sinus surgery in otolaryngology.

OBJECTIVE: To determine the scope of wrong-site sinus surgery. STUDY DESIGN: Electronic mail survey. SETTING: E-mailed via the American Academy of Otolaryngology-Head and Neck Surgery's weekly newsletter. SUBJECTS AND METHODS: Members were asked about wrong-site sinus surgery in an 11-item survey. RESULTS: A total of 455 members responded (response rate 19.8%). Forty-two (9.3%) have heard of a case of wrong-site sinus surgery occurring. Twenty-one cases were analyzed; of these, 10 (48%) implicated radiographic error, and the Universal Protocol was followed in one third. In seventeen reports (81%), there was disclosure to the family, one case with delayed disclosure; there was no disclosure in three cases. Sixty-one percent (n = 266) are concerned about operating on the wrong sinus or side. Forty-nine percent (n = 216) routinely use a checklist preoperatively. There is large variation in site marking for sinus surgery. Sixty-five percent (n = 282) routinely review the computed tomography scan prior to surgery. CONCLUSION: Approximately 10 percent of survey respondents know of a case of wrong-site sinus surgery occurring; the majority of respondents are concerned about a wrong-sinus or wrong-sided surgery occurring in their practice. Otolaryngologists should be vigilant regarding the potential for inverted computed tomography images; there should be national efforts to address this latent systems defect. Surgeons should be trained in understanding the role of and engaging in disclosure and in other techniques that are of greatest support to the patient. Consideration of sinus-specific checklists should be led by the societies representing sinus surgeons.

Epiglottitis in the United States: national trends, variances, prognosis, and management.

OBJECTIVES/HYPOTHESIS: To study national trends, variances, and outcomes in patients admitted with epiglottitis in the United States. We hypothesize that the incidence of epiglottitis has decreased, mortality has decreased, and that there has been a shift toward older patients being admitted with epiglottitis. STUDY DESIGN: Retrospective review of a dataset for years 1998, 2000, 2002, 2004, and 2006. METHODS: The Nationwide Inpatient Sample was searched using ICD-9 CM codes for epiglottitis with obstruction (464.30) and without obstruction (464.31). Characteristics studied included patient demographics, hospital information, and admission variables. Weighted admissions were analyzed to facilitate national estimates. RESULTS: There was a trend toward decreasing admissions over the study period, from 4587.17 cases (1998) to 3772.49 cases (2006); the mean over the study period was 4062.52 cases/year. The mean age of a patient with epiglottitis has remained relatively constant at 44.94 years over the study period; there are less frequent admissions in the 18 years and younger age cohorts, with an increase in the ages 45 to 64 years old and in patients over 85 years old. Mean length of stay is 4.15 days. Mean total charges for an admission of epiglottitis was $17,204.02 (standard deviation, $5,894). There was a trend toward increased total charges for the management of epiglottitis from total charges of $10,738.60 (1998) to $25,071.62 (2006). The South had a predominantly higher proportion of epiglottitis admissions during the study period. The gender distribution remained consistent over the study years at approximately 60:40 for males:female. Mortality remained constant at approximately 36 cases per year for a national mortality rate from epiglottitis of 0.89%. The month with the highest percentage of admissions was December; April was the month with the lowest. The majority of admissions were via the emergency department; patients were transferred in 2.88% of admissions. Over two thirds of admissions were Caucasian patients. Hospital level measures included the majority of patients were treated in an urban hospital location (82%); a minority (41%) were treated at a teaching hospital. Insurance status was private insurance in 50.02%, Medicare 20.84%, and Medicaid 12.46%. The proportion of patients that were intubated was 13.18%; 3.62% underwent a tracheotomy. Additional diagnoses in admitted patients included concomitant cardiovascular (38.75%), infectious (27.17%), respiratory (22.88%), diabetes (13.26%), and substance abuse (18.86%) diagnoses. CONCLUSIONS: An 8-year retrospective review of epiglottitis admissions revealed that epiglottitis continues to be a significant clinical entity in the United States. The portrait of a typical patient that will be admitted with epiglottitis is a mid-40-year-old, Caucasian, urban, male, with comorbid medical conditions, who will remain in the hospital on average for 4 days, resulting in total charges of $25,072 (2006 dollars). The majority of the mortalities are in adult patients. The majority of patients with epiglottitis has significant medical comorbid conditions and will be managed at the admitting hospital and not be transferred. This series identifies two newly recognized and uniquely vulnerable populations for epiglottitis: infants (<1 year old) and the elderly (patients >85 years old).

Management of foreign bodies obstructing the airway in children.

OBJECTIVE: To review national trends in the management of pediatric airway foreign bodies (A-FBs) and esophageal foreign bodies (E-FBs) that obstruct the airway. DESIGN: Retrospective review using a national pediatric data set (Kids' Inpatient Database). SETTING: Pediatric patients admitted across the United States during 2003. PATIENTS: The Kids' Inpatient Database 2003 samples 2 984 129 pediatric discharges from 3438 hospitals in 36 states. MAIN OUTCOME MEASURES: The Kids' Inpatient Database 2003 was analyzed for A-FBs and E-FBs (International Classification of Diseases, Ninth Revision, Clinical Modification codes E911 and E912) in patients 20 years or younger, and weighted data are presented to facilitate national estimates. RESULTS: A total of 2771 patients (59% male) were admitted for an A-FB or an E-FB that was obstructing the airway. The mean (SE) age of the patients was 3.5 (0.17) years; 55% were younger than 2 years. The foreign bodies were classified as food (42%; mean age, 2.5 years) or other (58%; mean age, 4.3 years). The average length of stay was 6.4 days (median [SE], 1.5 [0.6] days), and the average number of procedures was 2.4 (median [SE], 1.3 [0.1] procedures). Seventy-one percent of the patients were treated at teaching hospitals. The mean (SD) total charges were $34 652 ($3543), with regional variation (P < .001). Children's hospitals (28%) had higher mean total charges than nonchildren's hospitals (P = .03); 3.4% of admissions died in the hospital (mean [SE] age, 4.6 [0.9] years), with an average length of stay of 11.7 (SE, 2.7) days and an average of 6.2 (SE, 0.7) procedures. Bronchoscopy (52%), esophagoscopy (28%), and tracheotomy (1.7%) were the primary procedures performed. The rates of positive FB findings for bronchoscopy and esophagoscopy were 37% and 46%, respectively. CONCLUSIONS: Pediatric A-FBs and E-FBs that obstruct the airway occur infrequently. Most of the patients are referred to teaching institutions. Among patients who were admitted with a diagnosis of airway obstruction from an A-FB or an E-FB, the rates of positive findings at surgery were 37% and 46%, respectively. A surprisingly high mortality rate was noted. Alternative education measures should be considered to train physicians in the management of this infrequent, potentially lethal condition.

Retained foreign bodies during surgery in pediatric patients: a national perspective.

BACKGROUND: Attention has been placed on surgical and medical errors, though there is a lack of data on the frequency of some complications. METHODS: International Classification of Diseases, Ninth Revision, Clinical Modification, code 998.4 and E code 871.0 were used to search a database from the United States. RESULTS: In the Kids' Inpatient Database 2003, there were 103 reports of retained foreign bodies after surgery (incidence, 0.0031%) with a mean age of 11.5 years. There was a wide range between the 36 states sampled. Total charges for a patient with this complication are $56,683 (95% confidence interval, $41,327-$72,039); mean length of stay is 10.5 days. There is an increased charge of $42,077 in patients who have this complication (P < .0001). Of the cases, 74% occurred at teaching institutions. CONCLUSIONS: On a national perspective in the United States, the rate of a retained foreign body is 0.0031% or approximately 1 in 32,672 cases and is associated with an increased charge of $42,077 for this complication. Comparative data demonstrate that pediatric surgery in the United States is exceptionally safe with regard to retained foreign bodies.

Airway management in pediatric epiglottitis: a national perspective.

OBJECTIVES: The purpose of this study was to describe current demographics and resource utilization in the treatment of pediatric epiglottitis. STUDY DESIGN: Case series from a national database. SUBJECTS AND METHODS: The Kids' Inpatient Database was systematically searched to extract patients under 19 years old admitted with a diagnosis of epiglottitis and undergoing an airway intervention. RESULTS: Three hundred forty-two sampled admissions were for epiglottitis; 40 of these patients were under the age of 19 and had an airway intervention (intubation or tracheotomy). On average, patients were 4.3 years old (SD = 6.0 years). The average length of stay was 15.6 days (SD = 33.9 and range = 0-199) with average total charges of $74,931 (SD = $163,387, range = $3342-$938,512). Multivariate analysis revealed that admission to a children's facility, admission other than via the emergency room, and nonemergent admission were associated with increased total charges. Twenty-two states reported an admission for pediatric epiglottitis that required airway intervention. CONCLUSIONS: In our sample, only 40 patients were identified who were under the age of 19 years and required an airway intervention for the treatment of epiglottitis. Epiglottitis is a rare, expensive, and protracted disease to treat in the postvaccine era. The unique nature of this disease has implications for training future surgeons on proper management of this potentially fatal disease.

Existence of important variations in the United States in the treatment of pediatric mastoiditis.

OBJECTIVE: To determine national variations in resource utilization in the treatment of pediatric mastoiditis. DESIGN: Retrospective review. SETTING: National pediatric inpatient database. PATIENTS: The Kids' Inpatient Database for 2003 was used to extract data for admissions for mastoiditis. RESULTS: A total of 1049 patients (57% were male, and the mean age was 6.3 years) were identified. Median total charges for an admission were $9600; total charges were less than $28,604 in 90% of admissions. The mean length of stay (LOS) was 4.3 days (range, 0-87 days). A total of 792 procedures were performed; 50.0% of patients underwent tympanostomy tube placement and/or myringocentesis, and 21.6% underwent mastoidectomy. The LOS for nonsurgical patients was 3.7 days. The LOS for children undergoing tube placement was 4.6 days, with mean total charges of $15,713; for mastoidectomy, the LOS was 5.5 days, with mean total charges of $23,185. The primary payer was private insurance in 51.5% and Medicaid in 39.4%. Predictors of increased charges were treatment at teaching hospitals (P = .005), treatment at children's hospitals (P < .001), LOS (P < .001), the number of procedures (P < .001), and hospital region (P = .003). Wide geographic variation was noted with respect to the mean total charges per admission, which ranged from $5016 to $35,898. CONCLUSIONS: In 2003, the median charge for a pediatric mastoiditis admission was $9600; 50% of patients underwent tympanostomy tube placement, and about 21.6% underwent a mastoidectomy. There was wide variation in total charges for admissions. Resource utilization was higher in teaching hospitals and in children's' hospitals.

Pediatric retropharyngeal abscesses: a national perspective.

OBJECTIVES: To determine the resource utilization and national variation in the management of pediatric retropharyngeal abscesses. METHODS: The Kids' Inpatient Database (KID) 2003 was analyzed. International Classification of Diseases, Ninth Revision code 478.24 was the inclusion criteria. RESULTS: One thousand three hundred and twenty-one admissions with retropharyngeal abscess were sampled from the KID in 2003; there were no deaths. The mean age of patients was 5.1 years (S.D. 4.4 years); 63% were male. Of all admissions, 563 (43%) patients underwent surgical drainage of their infection; surgical patients had longer length of stays and total charges than patients managed medically. The average state spending per admission varied from $5126 (Utah) to $27,776 (California). There was seasonal variation in admissions with the highest percentage of admissions occurring in March (10.7%) and lowest in August (3.8%). Indicators of increased resource utilization included age (older patients), increased length of stay, non-elective admission, discharge quarter, and number of other diagnoses on record. There is a statistically significant decrease in the length of stay and total charges in patients admitted in the Midwest compared to other regions of the country. CONCLUSIONS: This study demonstrates national demographics and normative data on a commonly treated pediatric disease process, retropharyngeal space infections. The average demographic of such a patient is a 5-year-old male from an urban location admitted in a non-elective fashion via the emergency department. The mean total charges were $16,377; 90% of admissions had total charges less than $28,511. Patients who underwent surgical procedures had mean total charges of $22,013. There exists significant national variation in resource utilization for this commonly treated disease process.

Resource utilization in the management of subglottic stenosis.

OBJECTIVE: The purpose of this study was to determine resource utilization in managing subglottic stenosis. STUDY DESIGN: The Kids' Inpatient Database (KID) 2003 was analyzed. SUBJECTS AND METHODS: International Classification of Diseases, Ninth Revision code 478.74 was the inclusion criteria. RESULTS: Two thousand forty-six admissions with subglottic stenosis were sampled; there were 10 deaths (0.49%). States with the most admissions were Ohio, California, and Illinois; these did not have the highest spending per admission. Two hundred eighteen (10.7%) underwent a laryngeal graft procedure; states with the most were Ohio (35.8%), Texas, California, and Florida. Indicators of increased resource utilization include length of stay, nonelective admission, race, primary payer, hospital location, and type. CONCLUSIONS: For subglottic stenosis, three states account for 37% of admissions, and four states account for 56% of laryngeal graft procedures in 2003. The mean total charges were $53,787; 90% of admissions had total charges less than $139,253. Patients who underwent surgical procedures had total charges of $76,409.