Cost Analyisis of Mandible Distraction Versus Tracheostomy in Congenital Micrognathia: A Large Single Center Series

Infants with Pierre Robin sequence and moderate to severe airway obstruction need immediate management of their airway. Tracheostomy and mandibular distraction are different approaches to treat them. Before either surgery can be performed several other procedures are used to asses the cause of airway obstruction. The use of 3D-CT scan, magnetic resonance images, x-rays of the head and chest, and microlaryngoscopy and bronchoscopy can all help in assessing the cause and severity of blockage. While the airway is being assessed and stabilized, infants often need to be admitted to the hospital and in some cases for extended periods of time. The combined charges for medical procedures, hospital stays, consultation by specialists and home care requirements in addition to charges for the actual surgical procedure can be high.

This study includes a retrospective review of medical charts and billing records of 149 patients from 1994-2010 who receive a tracheostomy, and an additional 149 who underwent mandibular distraction at a single center during their first 2 years of life. Analysis of the difference in cost between tracheostomy and mandibular distraction, examining the charges for each surgery, as well as important medical procedures and consultations require over the same period of life.

There was a significantly higher average cost associated tracheostomy when compared to mandibular distraction (p=0.0001, p=0.0002 respectively). Mandibular distraction was more expensive than tracheostomy over the first three months of life but this difference was not statistically significant. However the significant difference between the two treatment groups was lost when private duty nursing was excluded from tracheostomy groups. This was true for isolated, syndromic, and combined Pierre Robin Sequence patients. Tracheostomy was also significantly less expensive without private duty nursing than with it (p<0.01). Private duty nursing was calculated assuming a nurse would be present for 8 hours a day, 5 days a week. The addition of this care for patients with tracheostomies dramatically increases the overall costs of this procedure.

There is a significantly higher average cost associated trachesotomy when compared to mandibular distraction. The difference in cost is due to charges that occur after the first three months of life. This indicates that the long-term care necessary for maintaining a tracheostomy makes it significantly more expensive treatment over time compared to mandibular distraction. This study offers long term analysis of a large cohort of distraction patients from a single center, and provides further evidence that distraction is not only clinically superior, but also provides significant cost-savings when compared with tracheostomy as a treatment for congenital micrognathia.