2015 HSC Section 1 Book of Articles

Otolaryngology–Head and Neck Surgery 151(5)

Table 3. Three Year Cost-Related Aspects of Mandibular Distraction versus Tracheostomy.

Trach 1 MD n = 9

MD n = 26

Trach n = 12

P Value a

Treatment

Median number operations year 1 (range) (Mean) Median number operations years 1-3 (range) (Mean) Median number ER visits years 1-3 (range) (Mean)

3.5 (2-6) (3.6) 4 (2-11) (3.9) b 0 (0-14) (1.0)

5 (2-6) (4.4)

6 (4-8) (6.0) 8 (4-15) (9.8) 1 (0-10) (3.1)

.0006

\ .0001

10 (6-12) (9.2) 1.5 (0-11) (3.2)

.016

Tracheostomy tube (n decannulated)

n/a

4

5

.40

4, 3, 4 c 6, 3, 3 c

\ .0001 \ .0001

Nasogastric tube (n treated, n home with, n weaned from) Gastrostomy tube (n treated, n home with, n weaned from)

22, 14, 22

0, 0, 0 9, 9, 2

4, 3, 3

Abbreviations: MD, mandibular distraction only; Trach, tracheostomy only; Trach 1 MD, tracheostomy with subsequent mandibular distraction. a Kruskal-Wallis test for continuous variables or Fisher’s exact test for categorical variables. b Two of 26 patients in the MD group had persistent airway obstruction requiring subsequent tracheostomy. c For nasogastric and gastrostomy tube data, only the proportion of patients treated was analyzed.

100000 120000 140000 160000 180000

100000 120000 140000 160000

MD Trach Trach+MD

MD Trach Trach+MD

0 20000 40000 60000 80000

0 20000 40000 60000 80000

the first year were no different ( P = .83) between the MD group ($53,489) and the Trach 1 MD group ($59,761), whereas the Trach group ($96,674) continued to be signifi- cantly higher than the MD group ( P = .002). The first year was divided into quartiles for a further anal- ysis of associated charges ( Figure 1 ). As expected, all groups had the greatest charges during the first quartile, cor- responding with the initial admission and operations, with no differences between groups ( P = .28). The low median charges of the Trach 1 MD group during the first quartile were influenced by a delay in receiving MD until after the initial tracheostomy. Over the last 3 quartiles, charges for the MD group were significantly less than those of the other 2 groups ( P \ .0001). Q4 Figure 1. Charges ($USD) of groups over first year by quartile. Total charges over the first year following initial surgical interven- tion for patients with Pierre Robin sequence receiving mandibular distraction (MD), tracheostomy (Trach), or tracheostomy with sub- sequent MD (Trach 1 MD). Median values (horizontal line) are pre- sented with twenty-fifth through seventy-fifth percentile ranges. Statistical analyses by quartile: first: P = .28; second through fourth: P \ .0001 (Kruskal-Wallis comparison for nonparametric data). Q1 Q2 Q3

A 3-year follow-up period was examined for all patients ( Figure 2 ). As with the first year ( P = .017), charges from the Trach and Trach 1 MD groups continued to be signifi- cantly greater than the MD group in years 2 ( P \ .0001) and 3 ( P = .0003). These increased costs correlate positively with increased numbers of operations ( P \ .0001) and ER visits ( P = .016) for patients receiving tracheostomy ( Table 3 ). To incorporate home tracheostomy care-related costs, a personalized estimate was made for each patient based on individual requirement for respiratory support, length of time prior to decannulation, and charges related to equip- ment rental, tracheostomy supplies, and home nursing care. These home care charges were combined with actual Year 1 Year 2 Year 3 Figure 2. Annual charges ($USD) of groups over a 3-year period. Cost analysis of patients with Pierre Robin sequence receiving mandibular distraction (MD), tracheostomy (Trach), or tracheost- omy with subsequent MD (Trach 1 MD), over a 3-year period following initial treatment. Median values (horizontal line) are presented with twenty-fifth through seventy-fifth percentile ranges. Statistical analyses by year: year 1: P = .017; year 2: P \ .0001; year 3: P = .0003 (Kruskal-Wallis comparison for nonparametric data).

65