86 / 280
Trach
1
MD (56%) groups, although this was not statistically
significant (
P
= .10).
Table 2
shows that the MD group had significantly
lower charges ($47,858) during the first year compared to
the tracheostomy ($107,139) and Trach
1
MD ($84,333)
groups (
P
= .017). This difference was due in part to differ-
ent surgical charges between the groups, with MD
($18,151) the lowest, Trach ($24,045) in between, and
Trach
1
MD ($30,028) the highest (multiple comparisons of
means,
P
\
.001), which directly correlated with increased
operation frequency for those receiving tracheostomy due to
serial gastrostomy tube and airway maintenance procedures
(eg, ML&B, removal of subglottic granulations,
Table 3
).
Patients receiving MD (28 days) and Trach (33 days) had
similar lengths of stay, however those with both operations
(50 days) had longer stays (multiple comparisons of means,
P
= .04). However, this difference did not correlate with
ICU-related charges. Surprisingly, the Trach group had
higher ICU charges ($73,845) than the Trach
1
MD
($32,559) and MD ($25,230) groups (multiple comparisons
of means,
P
= .007). When adjusted for the different lengths
of stay between the 3 groups, the total average charges for
Table 2.
Year 1 Cost-Related Aspects of Mandibular Distraction versus Tracheostomy.
a
Treatment
MD
n = 26
Trach
n = 12
Trach
1
MD
n = 9
P
Value
Age (days) at first surgery: median (range)
19 (6-233)
16 (0-32)
3 (0-105)
Age (days) at second surgery: median (range)
105 (17-210)
Total days of hospital stay: median (range)
Mean (SD)
28 (5-72)
31.5 (18.4)
33 (12-67)
33.7 (18.5)
50 (6-154)
55.4 (41.5)
.10
.04
Operation room–related charges year 1: median
Mean (SD)
$18,151
$17,552 ($5102)
$24,045
$23,705 ($9007)
$30,028
$30,680 ($8983)
.001
b
\
.001
Hospital-related charges year 1: median
Mean (SD)
$25,230
$30,318 ($22,567)
$73,845
$87,904 ($85,990)
$32,559
$46,310 ($40,156)
.15
.007
Total charges year 1: median
Mean (SD)
$47,858
$53,890 ($25,394)
$107,139
$126,516 ($96,286)
$84,333
$87,829 ($43,481)
.017
.002
c
Adjusted for days in hospital: mean
(95% confidence intervals)
$53,489
($44,549-$64,223)
$96,674
($74,076-$126,166)
$59,761
($43,177-$82,716)
Abbreviations: MD, mandibular distraction only; Trach, tracheostomy only; Trach
1
MD, tracheostomy with subsequent mandibular distraction.
a
Medians and ranges and means (SD) reported for all continuous values. Costs do not include tracheostomy supplies or private nursing care. All costs
adjusted for inflation. Comparisons across groups regarding continuous variables conducted using Kruskal-Wallis test (nonparametric).
b
Post hoc group comparison
P
values adjusted for multiple comparisons with Bonferonni correction. Groups MD versus Trach,
P
= .09; MD versus
Trach
1
MD,
P
= .0002; Trach versus Trach
1
MD,
P
= .44.
c
Because the data were not normally distributed (significantly skewed), cost values were log transformed to conduct general linear models to obtain an
adjusted mean with 95% confidence intervals and then back-transformed to provide an estimated cost in dollar figures for each group. Group comparison
P
values using Tukey-Kramer adjustment for multiple comparisons. MD versus Trach,
P
= .002; MD versus Trach
1
MD,
P
= .83; Trach versus Trach
1
MD,
P
= .07.
Table 1.
Demographics of Patients with Pierre Robin Sequence Included in the Study.
Treatment
MD
Trach
Trach
1
MD
Number of patients
26 (55%)
12 (26%)
9 (19%)
Gender distribution
Female = 12
Male = 14
Female = 6
Male = 6
Female = 4
Male = 5
Isolated PRS
22 (85%)
7 (58%)
5 (56%)
Syndromic PRS
*
4 (15%)
5 (42%)
4 (44%)
Treacher-Collins
Hemifacial microsomia
Stickler
Unknown
Treacher-Collins
Moebius
Miller
Popliteal Pterigium
Velocardio-facial
Nager
Mansky-Catel
Cornelia de Lange
Unknown
Abbreviations: MD, mandibular distraction only; Trach, tracheostomy only; Trach
1
MD, tracheostomy with subsequent mandibular distraction; PRS, Pierre
Robin sequence.
*
P
= .10 (Fisher exact test).
Runyan et al
64