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What factors influence the cost of orthognathic surgery among patients in the US?
Dani Stanbouly1, Harish Tummala2, Nicholas H Shleiwet1
1Columbia University College of Dental Medicine, New York, NY, USA.
Insights
Orthognathic surgery costs in the US are influenced by procedure type, length of stay, and complications. Maxillary osteotomy, bimaxillary surgery, and longer hospital stays significantly increase overall charges.
Area of Science:
- Oral and Maxillofacial Surgery
- Health Services Research
Background:
- Orthognathic surgery is a complex procedure aimed at correcting jaw and facial irregularities.
- Understanding cost-influencing factors is crucial for healthcare providers and patients.
Purpose of the Study:
- To identify key factors impacting the total hospital charges for orthognathic surgery in the United States.
- To analyze the association between specific surgical procedures, patient characteristics, and hospital costs.
Main Methods:
- Retrospective cohort study utilizing the Kids' Inpatient Database (KID) from 2000 to 2012.
- Inclusion criteria: patients aged 14-20 years undergoing orthognathic surgery.
- Multivariate linear regression analysis to identify predictors of hospital charges.
Main Results:
- A total of 14,191 patients were analyzed.
- Increased hospital charges were associated with longer length of stay (+$8123 per day).
- Maxillary osteotomy (+$5703), bimaxillary osteotomy (+$9419), genioplasty (+$3499), blood transfusion (+$11,719), and mechanical ventilation (+$23,502 to +$30,901) significantly increased costs.
- Obstructive sleep apnea (OSA) added $6560 to charges.
Conclusions:
- Maxillary and bimaxillary osteotomies incur higher charges than mandibular osteotomies.
- Concomitant procedures like genioplasty, transfusions, ventilation, and conditions like OSA significantly elevate orthognathic surgery costs.
- Reducing length of stay and managing complications are key to controlling hospital charges.
Objective:
The purpose of our study was to analyze what factors influence the cost of orthognathic surgery performed within the US.
Study Design:
This retrospective cohort study was completed using the Kids' Inpatient Database (KID) from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic surgery. The predictor variables included patient and hospitalization characteristics. The primary outcome variable was hospital charge ($). Multivariate linear regression was conducted to determine independent predictors for increased/decreased hospital charge.
Results:
The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females, 59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499, P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive sleep apnea (OSA) added $6560 in hospital charges (P < .01).
Conclusions:
Maxillary osteotomy and bimaxillary surgery were each associated with significantly increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC, CIMV, and OSA each significantly increased the charges. Each additional day to the length of stay significantly increased the charges.
