Botox injections with and without general anesthesia for pediatric sialorrhea: A cost, efficacy, and safety analysis

Ultrasound-guided salivary gland Botulinum toxin A (Botox) injections are often used in pediatric patients with refractory sialorrhea, performed with or without general anesthesia. This study aims to compare outcomes and costs between these methods.

Retrospective cohort study.

Tertiary children's hospital.

Patients with chronic sialorrhea refractory to medical therapy who underwent Botulinum toxin A injections between 2012 and 2023 under general anesthesia (n = 50; 126 injections) were compared to those performed without general anesthesia (n = 31; 116 injections). Sociodemographic factors, clinical history, and injection regimen were recorded. Available billing data from this time period was used to compare costs.

Pediatric patients who underwent Botulinum toxin A injections without general anesthesia did not have statistically significant differences in post-injection cessation of anticholinergic medications (AOR = 0.980, [0.29, 3.29]), family-reported improvement in sialorrhea (AOR = 3.25, [0.58, 18.1]), admissions for aspiration pneumonia within the year (Coefficient = 0.260, [-0.22, 0.75]), or progression to sialorrhea surgery (AOR = 0.374, [0.07, 2.16]) compared to those performed under general anesthesia. Amongst patients who underwent repeat injections, there were no significant differences in the average number of injections (p = 0.41) or time between injections (p = 0.16). Botulinum toxin A injections performed in the outpatient setting ($1374.49) had significantly lower costs compared to injections performed under general anesthesia ($5077.13) (p < 0.001).

Pediatric patients undergoing Botulinum toxin A injections with and without general anesthesia have similar efficacy and quality outcomes. Exploring the advantages of Botulinum toxin A injections without general anesthesia could lead to improved access, reduced risks of general anesthesia, and reduced costs to the medical system.