Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX.

BACKGROUND: There were 2 main purposes of this retrospective chart review study. The first was to describe the demographic, social, and financial characteristics of patients with severe odontogenic infections. The second was to assess the relationships among several demographic, social, and treatment variables and length of stay (LOS) in the hospital and hospital bill (charges). METHODS: The authors conducted a retrospective chart review for patients admitted to the hospital and taken to the operating room for treatment of severe odontogenic infections at 3 hospitals in Houston, TX (Ben Taub, Memorial Hermann Hospital, and Lyndon B. Johnson) from January 2010 through January 2015. RESULTS: The authors included data from severe odontogenic infections in 298 patients (55% male; mean age, 38.9 years) in this study. In this population, 45% required admission to the intensive care unit, and the mean LOS was 5.5 days. Most patients (66.6%) were uninsured. The average cost of hospitalization for this patient population was $13,058, and the average hospital bill was $48,351. At multivariable analysis, age (P = .011), preadmission antibiotic use (P = .012), diabetes mellitus (P = .004), and higher odontogenic infection severity score (P < .001) were associated with increased LOS. Higher odontogenic infection severity score, diabetes mellitus, and an American Society of Anesthesiologists score of 3 or more were associated with an increased charge of hospitalization. CONCLUSIONS: Severe odontogenic infections were associated with substantial morbidity and cost in this largely unsponsored patient population. The authors identified variables associated with increased LOS and charge of hospitalization. PRACTICAL IMPLICATIONS: Clinicians should consider these findings in their decision-making processes and prioritize early treatment of odontogenic infections potentially to decrease the number of patients admitted to the hospital, LOS, and overall costs of treatment for these infections.

Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?

PURPOSE: On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS: A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS: Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION: After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.

The cause of cost in the management of odontogenic infections 2: multivariate outcome analyses.

PURPOSE: The purpose of this retrospective cohort study was to evaluate the demographic, social, treatment, and hospital course variables associated with length of stay (LOS), intensive care unit (ICU) use, and additional operating room (OR) use in patients admitted for odontogenic infections. MATERIALS AND METHODS: A retrospective chart review was conducted in patients admitted for odontogenic infections at Harborview Medical Center from July 1, 2001 through June 30, 2011. RESULTS: In total, 318 patient charts were reviewed and included. In the multivariate linear regression analysis on LOS, the variables drug abuse, location of treatment, number of spaces involved, side or location of infection, ICU use, length of ICU stay, additional OR use, peak temperature, admission white blood cell count, peak white blood cell count, and peak blood sugar accounted for 68.2% of the variation. In the multivariate logistic regression analysis on ICU use, the variables OR time, number of spaces involved, and peak blood sugar accounted for 32.5% of the variation. LOS was the only variable significantly associated with additional OR use in the multivariate analysis. CONCLUSION: An understanding of the key variables involved in LOS in patients with odontogenic infections has been greatly improved by recent studies and reinforced by the present study. The authors present a starting point for a greater understanding of the variables involved in ICU use, but much more work is needed to address variables identifying patients requiring reoperation. Future studies should aim to create multivariate models explaining all variations in these outcome variables.

The cause of cost in the management of odontogenic infections 1: a demographic survey and multivariate analysis.

PURPOSE: The purpose of this retrospective cohort study was to describe the demographics of patients with odontogenic infections and to evaluate the costs associated with the demographic, social, treatment, and hospital course variables in patients hospitalized for odontogenic infections. MATERIALS AND METHODS: A retrospective chart review was conducted in patients admitted for odontogenic infections at Harborview Medical Center from July 1, 2001, through June 30, 2011. RESULTS: In total, 318 patient charts were reviewed and included. The unsponsored portion of the patient population increased from 14.7-61.9% over the course of the study. The average hospital bill per patient in this study was $17,053. Of the $5,422,854 billed, only $1,528,869 was received by the hospital in payment for services rendered, equating to $3,893,985 in lost potential revenue. The variables location of treatment, length of stay, length of stay in the intensive care unit, additional use of the operating room, and antibiotic regimen accounted for 90.2% of the variation in the hospital bill. CONCLUSION: Unsponsored patients constituting 61.9% of the patient population represent an enormous challenge for hospitals and providers. To maintain the standard of care for all patients and still be able to provide care to patients without insurance, county hospitals and academic institutions must seek to improve cost efficiency. The present findings reinforce the need to be vigilant about the decision to admit, take to the operating room, admit to an intensive care unit, and discharge to lower the costs to the patient, hospital, and society for the management of odontogenic infections.

The financial burden of hospitalization associated with odontogenic infections.

PURPOSE: Although it is generally agreed that there are high costs involved in the management of acute odontogenic infections in hospitalized patients, there are sparse data on the actual amounts involved. The purpose of this study was to examine the costs and charges associated with the treatment of such patients in a university medical center hospital. PATIENTS AND METHODS: Hospital records from 2003 through 2010 were reviewed for patients admitted for management of acute odontogenic infections, and 327 patients were identified. The cost of their hospital care, doctors' fees, and hospital charges (amount billed) were then determined. RESULTS: An average of 40 patients was seen each year. The cost of their care ranged from $1,035 to $252,888 (average, $9,417). This did not include doctors' charges. The hospital charges averaged $28,841 per patient. Over the 8-year period, the hospital costs exceeded $3.3 million and the charges submitted were in excess of $10 million. CONCLUSIONS: The management of acute odontogenic infections in the hospital engenders considerable costs. Although it would appear that the charges compensate for these costs, that figure does not represent the amount actually collected, which is much less based on the economic status of the patient population generally being treated. Methods to lower the costs associated with hospitalization are proposed.

Factors associated with length of stay and hospital charges for patients hospitalized with mouth cellulitis.

OBJECTIVE: Dental conditions that are neglected could progress to infectious lesions that are severe enough to require hospital admission for treatment. The objective of this study was to examine outcomes in patients hospitalized for cellulitis and abscesses of mouth in the USA in year 2008. STUDY DESIGN: The nationwide inpatient sample for the year 2008, a component database of the Healthcare Cost and Utilization Project, was used for the current study. All hospital discharges with a primary diagnosis for cellulitis or abscess of mouth (ICD-9-CM code 528.3) were selected for analysis. Outcomes, including length of stay in hospital (LOS) and hospitalization charges, were computed from the database and projected to national levels by using the discharge weight variable. The predictor variables were composed of sets of heterogeneous variables grouped into the following categories: demographic, health-related (comorbid conditions), hospital-specific, and insurance-related. The primary outcome variables were LOS and hospital charges. Multivariable linear regression analysis models were used to examine the association between predictor and outcome variables. RESULTS: A total of 4,044 hospital discharges were attributed primarily to cellulitis or abscess of mouth. About 45% of these discharges occurred in those aged between 18 and 45 years. The mean length of stay in hospital was 3.9 days, and the mean hospital charge was $24,290. The total USA hospitalization charge was close to $98 million. Private insurance plans were the major payers, accounting for $31 million of hospitalization charges. About 88% of all hospitalization were discharged routinely after treatment, and 2% were transfered to another short-term hospital. CONCLUSIONS: This study examines outcomes in patients hospitalized for cellulitis or abscess of mouth. Future studies must focus on identifying cohorts that are more prone to developing odontogenic infections that are severe enough to warrant hospitalization.

Oral infections: impact on human health, well-being, and health-care costs.

Both caries and periodontal disease as well as many diseases of the mucous membranes, tongue, and salivary glands are infectious. If left untreated or inadequately treated, they have profound systemic as well as local effects. Maintenance of oral health goes beyond the physiological needs of proper nutritional intake and protection of the oral tissues. It also includes protection against oral sources of systemic infection and encompasses a range of social and psychological attributes. The rising expectations of patients in the pursuit of comfort and esthetics has provided evidence of the oral contribution to quality of life. Oral infections and their sequela account for the major portion of annual dental expenditures.

Risk factors affecting hospital length of stay in patients with odontogenic maxillofacial infections.

PURPOSE: This study identified potential risk factors associated with increasing hospital length of stay (LOS) in patients with odontogenic maxillofacial infections. PATIENTS AND METHODS: One hundred twenty-eight patients admitted to Brigham and Women's Hospital by the Division of Oral Surgery between October 1, 1984 and March 31, 1995 with a maxillofacial infection of dental origin were retrospectively identified by a medical chart review. Linear regression techniques were used to explain the relationship between patient admission characteristics and LOS. Variables considered included age, gender, infection location, admission white blood count (WBC), admission temperature, antibiotic treatment during hospitalization, attending surgeon, insurance class, operating room use (ORU), and preexisting medical conditions associated with chronic immunosuppression. RESULTS: The following variables were found to significantly increase LOS: ORU (P = .007), preexisting medical conditions (P < .0001), admission temperature (P = .022), and deep infection (P = .063). CONCLUSION: LOS is best predicted on the basis of underlying medical conditions and location of the infection.