Economic Burden of Inpatient Odontogenic Infections in the United States

Odontogenic infections represent a significant yet preventable cause of health care expenditure in the United States. However, their economic burden is not well defined.

The purpose of this study was to estimate the per-admission hospital costs of managing odontogenic infections and identify factors associated with increased cost.

This was a retrospective cohort study using the National Inpatient Sample database from years 2017 to 2019. Adults admitted for management of an odontogenic infection based on ICD-10 coding were included. Patients under 18 years or missing outcomes data were excluded.

The predictors were variables categorized into demographic (age, sex), clinical (Charlson comorbidity index), procedural (incision and drainage), and hospital characteristics (teaching status) groups.

The outcome was economic burden measured as the total hospital cost of admission, derived by applying hospital-specific cost to charge ratios to reported charges and adjusting for inflation to 2019 dollars.

None.

Survey-weighted descriptive, bivariate, and generalized linear model statistics were used to evaluate the association between cost and study variables. Costs were log-transformed in analyses to address for right skew. Effects are reported as cost ratios (CRs) or the multiplicative change in expected cost versus the reference group; for continuous variables, the CR reflects the change per one-unit increase.

There were 52,250 weighted admissions (∼17,417/year) with a mean age of 41.8 ± 20.5 years and 24,655 males (47.2%). The mean and median costs per admission were $8,162 ± 10,282 and $5,863 [IQR $3,744 to 9,013], respectively. The total annual national cost was $142 million. In adjusted analysis, higher costs were primarily driven by disease severity with airway intervention (CR 3.04, 95% CI 2.83 to 3.27), mediastinitis (CR 2.50, 95% CI 1.73 to 3.62), necrotizing fasciitis (CR 1.79, 95% CI 1.34 to 2.38), sepsis (CR 1.30, 95% CI 1.25 to 1.35), and incision and drainage (CR 1.20, 95% CI 1.17 to 1.24) having the highest CRs (all P < .001). Time to drainage in days (CR 1.13, 95% CI 1.11 to 1.15) was the only modifiable driver.

Inpatient management of odontogenic infections imposes substantial national costs, driven largely by markers of disease severity.