What Is the Health Care Burden of Treating Pediatric Dental Infections on an Inpatient Basis?

Abstract

The purpose of this study was to quantify the inpatient burden of pediatric dental infections. This was a retrospective study of the Kids' Inpatient Database from 2000 to 2014. Patients with a primary admitting diagnosis of cellulitis or an abscess of the oral soft tissues were included. Predictors were drawn from patient characteristics and the types of interventions performed. The outcomes were hospital charges, length of stay (LOS), and procedure count. Multiple linear regression models for each outcome were created using all the predictors. The final sample included 1,779 patients. On average, admissions lasted 2.77days, patients had a single (1.03) procedure performed, and hospitals billed for $12,729.37. During hospitalization, 41.4% of patients received definitive treatment (incision and drainage or dental extraction), with very few patients requiring some form of mechanical ventilation (2.4%) or a tracheostomy (0.9%). After we controlled for other predictors, dental stage (primary, mixed, or permanent) did not significantly influence the study outcomes. The presence of a medical comorbidity increased the LOS (+0.54days) and hospital charges (+$3,338.81) but did not carry a need for additional procedures. Definitive treatment contributed to the cost of care (+$5,582.96) but did not meaningfully prolong hospitalization (+0.41days) when considering the procedure and anesthesia time. Although uncommon, tracheostomy and ventilation independently had the largest impact on all study outcomes. On the basis of national estimates, the majority of pediatric odontogenic infections appear to follow an uncomplicated hospital course. Definitive treatment increased the cost of care but did not meaningfully prolong the LOS. This finding suggests that additional management is not usually required once source control is achieved. Future economic studies should evaluate whether definitive treatment may be safely provided on an outpatient basis or under observation status for select patients.