International journal of pediatric otorhinolaryngology · 2025
Botox injections with and without general anesthesia for pediatric sialorrhea: A cost, efficacy, and safety analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Lindeborg Michael M, Civantos Alyssa M, Florentine Michelle, Meyer Anna K, Rosbe Kristina W
Аннотация
OBJECTIVE: 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.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary children's hospital.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary children's hospital.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.