Economic Burden of Inpatient Odontogenic Infections in the United States.

BACKGROUND

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

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

STUDY DESIGN, SETTING, AND SAMPLE: 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.

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

MAIN OUTCOME VARIABLE: 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.

COVARIATES: None.

ANALYSES: 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.

RESULTS

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.

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