Cost Determinants of Mandibular Distraction Osteogenesis in Infants with Robin Sequence

Abstract

Background: Robin sequence is an anomaly of micrognathia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) performed in early infancy relieves airway obstruction and improves feeding difficulties. Though clinical outcomes data for MDO are strong, studies examining the cost drivers of the procedure are scarce. Methods: A retrospective 10-year single-institution chart review examined medical and billing records of infants undergoing MDO at an urban tertiary care center. Data included hospital charges, patient characteristics, comorbidities/complications, intubation duration, and length of stay (LOS). Multivariate regression analysis determined significant cost contributors over the course of admission. Conclusions from this smaller sample were compared with analyses from a larger, less detailed, population-based inpatient registry using the Kids' Inpatient Database (2016 and 2019). Results: In the single-institution analysis, 29 cases were identified with a mean age of 12 days at hospital admission. Mean postoperative and overall LOS were 19 ± 10 and 31 ± 13 days, respectively. Mean total charges were $287K-$118K. The most significant driver of total charges was floor charges (P < 0.01). LOS was a proxy for floor charges, as they were highly correlated (r = 0.98). LOS was significantly driven by intubation duration (P = 0.01). In the nationwide analysis, 165 weighted cases were identified; mean age was 2 months at hospital admission. Mechanical ventilation >96 hours was associated with increased LOS and hospitalization costs. Conclusions: Of infants with Robin sequence undergoing MDO, the most significant driver of total charges was LOS. Intubation duration was highly associated with LOS.