Financial Analysis of Routine Intensive Care Unit Admission Following Palatoplasty in Patients with Robin Sequence
Nicole C. Episalla*, Esperanza Mantilla-Rivas, Amir Elzomor, John Thomas, MONICA MANRIQUE, Md Sohel Rana, Gary F. Rogers, Albert Oh
Plastic and Reconstructive Surgery, Children's National Hospital, Washington,
Our institution recently demonstrated that infants with Robin Sequence (RS) whose early upper airway obstruction (UAO) was appropriately managed by conservative measures or mandibular distraction may be safely admitted to a surgical ward for post-operative monitoring instead of the pediatric intensive care unit (PICU) after primary palatoplasty (PP). This study aimed to estimate the potential cost savings of admitting patients to the floor instead of the PICU following PP.
Patients who underwent UAO management for RS and subsequent PP at our institution between 2010-2020 were included. Demographics, type of airway management, admission level of care, total length of stay, and department charges were recorded. Costs of admission per day and total length of stay were compared between patients admitted to the PICU and floor.
Forty-five patients were included. Thirty patients were admitted to the PICU, and fifteen were admitted to the surgical ward. Overall, the median age at PP was 13.4 months (interquartile range (IQR), 11.4 - 16.7). Patients admitted to PICU were significantly older (median age 14.2 months [IQR, 12.4 - 16.4] vs. 11.3 months [IQR, 9.8 - 15.4], p=0.030). Over half of the patients had a syndromic association (53.3%); this subset of subjects showed a higher prevalence in admission to the PICU (60.0%) vs. surgical ward (40.0%) (p = 0.205). The average combined physician and hospital charges for total days of admission were $55,912.80 for those admitted to the PICU and $32,660.00 for those admitted to the floor (p=0.001). The average combined physician and hospital charges per day were $7,970.33 while in the PICU and $3,193.22 (p<0.001) while on the floor.
Admission of medically appropriate patients to the surgical ward after PP in patients with RS whose infantile airway was appropriately managed would result in significant financial savings. More importantly, selective admission to PICU for these patients may also conserve space and resources in the PICU for more critically ill patients.
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