2015 HSC Section 1 Book of Articles

injury and 34 patients died, representing a hospital mor- tality rate of 1.8% 6 0.4%. Data for length of stay, total charges, and actual costs were extracted and divided into quartiles because they were not normally distributed. The median length of stay was 3 days (25th–75th interquartile range, 1–7 days). The median charges and actual costs per case were $20,820 ($10,800–$53,453) and $6,720 ($3,628– 16,723), respectively. Table I presents the means for length of stay, charges, and actual costs for each quar- tile, as well as the overall means for these values. DISCUSSION Bronchial FBA continues to pose a significant healthcare concern in the pediatric population. Although the vast majority of these events are nonfatal, thousands of patients present to the emergency room for evalua- tion, procedures, and admissions. Our study, which included aggregated 2009 to 2011 data from the NIS, included information from nearly 1,149 (unweighted N) admissions. Incorporating sample weights and the struc- tured survey design variables from the NIS allows for extrapolation to an overall national estimate of 1,908 6 273 pediatric airway foreign bodies, with approx- imately $41.0 million in inpatient healthcare expendi- tures annually. There exists some heterogeneity in the literature regarding the most common type of foreign body aspi- rated among pediatric patients; a recent study reviewing 72 articles showed that 94% of studies reported food for- eign bodies as the most frequently aspirated items. 1 In our study, the ratio of nonfood object aspiration to food object aspiration in the study was 5:3. Regardless of whether an aspirated object is edible or not, its size and shape are important considerations. Various cylindrical and spherical objects (nuts, hard candies, grapes, mar- bles) are capable of occluding the pediatric airway. 1 What remains constant and perpetually concerning is the morbidity of these events, as well as the nonnegli- gible incidence of anoxic brain injury and death (2.2% and 1.8%, respectively, in this study). This is the first study to quantify the incidence of anoxic brain injury with bronchial foreign body aspiration. Clearly, these rates for anoxic brain injury and mortality are concern- ing in and of themselves. Currently, to our knowledge, no studies reviewing data regarding only airway FBA admissions have been performed. There does exist a study of patient admis- sions for both airway and esophageal foreign bodies from the Kids’ Inpatient Database 2003 performed by Shah et al.; there was a 3.4% mortality rate among patients and the average length of stay was 11.7 days. 5 The mean total charges were $34,652. 5 Our study, which focused on bronchial foreign body aspirations alone, showed a $20,820 charge for each hospital admission and an annual overall inpatient cost associated with pediatric bronchial FBA to be approximately $12.8 mil- lion. One notable difference between our study and that of Shah et al. concerns the sampled hospitals. Shah et al. examined foreign body admissions in a database of

TABLE I. Quartile Stratification and Overall Mean Length of Stay, Actual Costs, and Total Charges per Hospital Admission.

Quartile Mean Length of Stay Actual Costs ($)

Total Charges ($)

0.80 6 0.02 days 2,306 6 52

6,518 6 173

First

Second 2.00 6 0.01 days 5,046 6 57 15,371 6 171 Third 4.12 6 0.07 days 10,648 6 211 33,118 6 699 Fourth 21.0 6 1.13 days 68,475 6 3831 209,537 6 14,207 Overall mean 7.08 6 0.96 days 21,479 6 2,432 65,590 6 7,819

hospital institutional review board and deemed exempt from review. For each of these calendar years, all admissions with a pediatric (age ! 16 years) foreign-body aspiration diagnosis code (International Classification of Diseases [ICD]-9 diagnosis codes: 934.0, 934.1, 934.8, and 934.9) were extracted. The data were then imported into SPSS (version 21.0, Chicago, Illinois) for analysis. Standard descriptive demographic information was com- puted for the admission population. The incidence of food ver- sus object aspiration, the airway procedure intervention rate (ICD-9 procedure codes—bronchoscopy: 33.22, 33.23, and 33.24; bronchoscopy with foreign body removal: 98.15; laryn- goscopy or tracheoscopy: 31.42; foreign body removal from lar- ynx, pharynx, or site not otherwise specified: 98.13, 98.14 and 98.20) were determined. Data for length of stay, total charges, and actual costs were extracted and divided into quartiles because they were not normally distributed. The mean values for length of stay, total charges, and actual costs were com- puted for each quartile. Finally, disposition status for the population including inpatient death and the incidence of anoxic brain injury (ICD-9 code 348.1) was also tabulated. Data were analyzed using the complex sample algorithm, which takes into account survey design variables contained within the NIS that allow for estima- tion of these variables at the national level. In accordance with published analyses from the Agency for Healthcare Research and Quality, data were considered reliable as a national esti- mate if the relative standard error of the estimate was less than 30%. 4 RESULTS An estimated 1,908 6 273 pediatric bronchial foreign-body aspiration patients were admitted annually over a 3-year period. Of this group, 61.3% 6 1.9% were male, with an average age at presentation of 3.6 6 0.25 years. The ratio of nonfood foreign object aspiration to food aspiration was 5:3. Approximately half of the patients (56.0 6 3.6%) underwent an airway endoscopic procedure (1068 6 117 cases, annually) for diagnostic and/or therapeutic purposes. Among those children undergoing airway endoscopy, 41.5% 6 2.5% had a for- eign body removed at the time of the endoscopy. Follow- ing their hospital stay, 86.6% 6 2.0% of patients were discharged to home without nursing care; 5.3% 1 1.6% were discharged to home with home healthcare; 3.5% 1 0.7% were transferred to another hospital; and 2.6% 1 0.5% were transferred to a skilled care facility. Forty-one patients (2.2% 6 0.5%) suffered anoxic brain

Laryngoscope 00: Month 2014

Kim et al.: Cost of Foreign Body Aspiration in Children

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