2015 HSC Section 1 Book of Articles

Runyan et al

Table 1. Demographics of Patients with Pierre Robin Sequence Included in the Study. Treatment MD

Trach 1 MD

Trach

Number of patients Gender distribution

26 (55%)

12 (26%)

9 (19%)

Female = 12 Male = 14

Female = 6 Male = 6

Female = 4 Male = 5

Isolated PRS

22 (85%) 4 (15%)

7 (58%) 5 (42%)

5 (56%) 4 (44%)

Syndromic PRS *

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).

Table 2. Year 1 Cost-Related Aspects of Mandibular Distraction versus Tracheostomy. a

Trach 1 MD n = 9

MD n = 26

Trach n = 12

Treatment

P Value

Age (days) at first surgery: median (range) Age (days) at second surgery: median (range) Total days of hospital stay: median (range) Mean (SD) Operation room–related charges year 1: median Mean (SD)

19 (6-233)

16 (0-32)

3 (0-105)

105 (17-210)

28 (5-72) 31.5 (18.4)

33 (12-67) 33.7 (18.5)

50 (6-154) 55.4 (41.5)

.10 .04

.001 b

$18,151 $17,552 ($5102) $25,230 $30,318 ($22,567) $47,858 $53,890 ($25,394) $53,489 ($44,549-$64,223)

$24,045 $23,705 ($9007) $73,845 $87,904 ($85,990) $107,139 $126,516 ($96,286) $96,674 ($74,076-$126,166)

$30,028 $30,680 ($8983) $32,559 $46,310 ($40,156) $84,333 $87,829 ($43,481) $59,761 ($43,177-$82,716)

\ .001

Hospital-related charges year 1: median Mean (SD)

.15 .007 .017 .002 c

Total charges year 1: median Mean (SD)

Adjusted for days in hospital: mean (95% confidence intervals)

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.

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

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