Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center

  • Kim, Hye-Won (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • Received : 2021.03.03
  • Accepted : 2021.05.11
  • Published : 2021.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods: A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results: Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion: For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

Keywords

References

  1. Abramowicz S, Rampa S, Allareddy V, Lee MK. The burden of facial cellulitis leading to inpatient hospitalization. J Oral Maxillofac Surg 2017;75:1656-67. https://doi.org/10.1016/j.joms.2017.01.032
  2. Eisler L, Wearda K, Romatoski K, Odland RM. Morbidity and cost of odontogenic infections. Otolaryngol Head Neck Surg 2013;149:84-8. https://doi.org/10.1177/0194599813485210
  3. Christensen B, Han M, Dillon JK. The cause of cost in the management of odontogenic infections 2: multivariate outcome analyses. J Oral Maxillofac Surg 2013;71:2068-76. https://doi.org/10.1016/j.joms.2013.05.027
  4. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, Trieger N. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg 2006;64:1093-103. https://doi.org/10.1016/j.joms.2006.03.015
  5. Gams K, Shewale J, Demian N, Khalil K, Banki F. Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX. J Am Dent Assoc 2017;148:221-9. https://doi.org/10.1016/j.adaj.2016.11.033
  6. Ahmad N, Abubaker AO, Laskin DM, Steffen D. The financial burden of hospitalization associated with odontogenic infections. J Oral Maxillofac Surg 2013;71:656-8. https://doi.org/10.1016/j.joms.2012.11.024
  7. Hurley RH, Douglas CM, Montgomery J, Clark LJ. The hidden cost of deep neck space infections. Ann R Coll Surg Engl 2018;100:129-34. https://doi.org/10.1308/rcsann.2017.0193
  8. Allareddy V, Rampa S, Nalliah RP, Allareddy V. Longitudinal discharge trends and outcomes after hospitalization for mouth cellulitis and Ludwig angina. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:524-31. https://doi.org/10.1016/j.oooo.2014.06.003
  9. Jundt JS, Gutta R. Characteristics and cost impact of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:558-66. https://doi.org/10.1016/j.oooo.2011.10.044
  10. Shah AC, Leong KK, Lee MK, Allareddy V. Outcomes of hospitalizations attributed to periapical abscess from 2000 to 2008: a longitudinal trend analysis. J Endod 2013;39:1104-10. https://doi.org/10.1016/j.joen.2013.04.042
  11. Kim MK, Allareddy V, Nalliah RP, Kim JE, Allareddy V. Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:312-7. https://doi.org/10.1016/j.tripleo.2011.07.043
  12. Kim MK, Nalliah RP, Lee MK, Allareddy V. Factors associated with length of stay and hospital charges for patients hospitalized with mouth cellulitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:21-8. https://doi.org/10.1016/j.tripleo.2011.01.012
  13. Jansisyanont P, Kasemsai W, Bamroong P. Factors related to the treatment outcome of maxillofacial fascia space infection. J Oral Maxillofac Surg Med Pathol 2015;27:458-64. https://doi.org/10.1016/j.ajoms.2014.04.009
  14. Zhang C, Tang Y, Zheng M, Yang J, Zhu G, Zhou H, et al. Maxillofacial space infection experience in West China: a retrospective study of 212 cases. Int J Infect Dis 2010;14:e414-7. https://doi.org/10.1016/j.ijid.2009.08.002
  15. Mathew GC, Ranganathan LK, Gandhi S, Jacob ME, Singh I, Solanki M, et al. Odontogenic maxillofacial space infections at a tertiary care center in North India: a five-year retrospective study. Int J Infect Dis 2012;16:e296-302. https://doi.org/10.1016/j.ijid.2011.12.014
  16. Yew CC, Ng MP, Ling XF, Tew MM. Orofacial infection and influencing factors on prolonged hospital stay: a four year retrospective study of 207 cases. J Oral Maxillofac Surg Med Pathol 2021;33:7-12. https://doi.org/10.1016/j.ajoms.2020.06.007
  17. Park J, Lee JY, Hwang DS, Kim YD, Shin SH, Kim UK, et al. A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward. Maxillofac Plast Reconstr Surg 2019;41:49. https://doi.org/10.1186/s40902-019-0238-9
  18. Agarwal AK, Sethi A, Sethi D, Mrig S, Chopra S. Role of socio-economic factors in deep neck abscess: a prospective study of 120 patients. Br J Oral Maxillofac Surg 2007;45:553-5. https://doi.org/10.1016/j.bjoms.2007.01.001
  19. OECD. Health at a glance 2019: OECD indicators. Paris: OECD Publishing; 2019.
  20. Zheng L, Yang C, Zhang W, Cai X, Kim E, Jiang B, et al. Is there association between severe multispace infections of the oral maxillofacial region and diabetes mellitus? J Oral Maxillofac Surg 2012;70:1565-72. https://doi.org/10.1016/j.joms.2011.07.010
  21. Jang JW, Kim CH, Kim MY. Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients. J Korean Assoc Oral Maxillofac Surg 2015;41:251-8. https://doi.org/10.5125/jkaoms.2015.41.5.251
  22. Kang SK, Lee S, Oh HK, Kang MW, Na MH, Yu JH, et al. Clinical features of deep neck infections and predisposing factors for mediastinal extension. Korean J Thorac Cardiovasc Surg 2012;45:171-6. https://doi.org/10.5090/kjtcs.2012.45.3.171
  23. Christensen B, Han M, Dillon JK. The cause of cost in the management of odontogenic infections 1: a demographic survey and multivariate analysis. J Oral Maxillofac Surg 2013;71:2058-67. https://doi.org/10.1016/j.joms.2013.05.026
  24. Sohn M, Jung M. Effects of public and private health insurance on medical service utilization in the National Health Insurance System: national panel study in the Republic of Korea. BMC Health Serv Res 2016;16:503. https://doi.org/10.1186/s12913-016-1746-2
  25. Song YJ. The South Korean health care system. JMAJ 2009;52: 206-9.
  26. OECD. OECD Reviews of public health. Paris: OECD; 2020.
  27. Kruger E, Tennant M. Socioeconomic disadvantage and oral-health-related hospital admissions: a 10-year analysis. BDJ Open 2016;2:16004. https://doi.org/10.1038/bdjopen.2016.4
  28. Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg 2006;64:1104-13. https://doi.org/10.1016/j.joms.2006.03.031