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National Trends In Hospitalization Charges And Utilization Of Oral And Maxillofacial Surgery For Cleft Lip And Palate Patients
Yida Cai, BA, Arvin Smith, BS, Samuel Boas, BS, Cristin Coquillard, MD, Lesley Summerville, BS, ScM, Anand Kumar, MD.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.

PURPOSE: Patients with cleft lip and palate often require multiple maxillofacial and orthognathic surgeries throughout their management. However, the overall healthcare resource requirement and utilization of these procedures in this patient population remain poorly understood. The purpose of this study was to examine national trends in patient utilization and hospitalization charges associated with oral and maxillofacial surgeries for cleft lip and palate patients over multiple years. METHODS: The Healthcare Cost and Utilization Project National Inpatient Sample database was analyzed from January 2007 to December 2014. All patients who were diagnosed with cleft lip or palate who underwent oral and maxillofacial procedures were included. Variables of interest included demographic data, hospital characteristics, hospitalization data and total hospital charges. All charges were inflated to May 2019 value with the consumer price index. Univariate and generalized linear models were used to examine associations between various factors of interest and the final adjusted hospitalization charge as well as the change in these factors over the multiple years included. RESULTS: 62,471 patients were diagnosed cleft lip or palate during hospitalization between January 2007 and December 2014. Of these patients, 1292 (2.1%) received an oral and maxillofacial surgery, including osteoplasty of maxilla (879, 68.0%), genioplasty (30, 2.3%) and other facial bone repair and reconstruction (183, 14.2%) and were included in the study. Regression analysis showed that total procedure volume did not change significantly over the years examined (p = 0.199). Higher procedure volume (>10 cases/year) was associated with large bedsize hospitals (p < 0.001), non-profit private hospitals (p < 0.001) and urban teaching hospitals (p < 0.001). Only one observed case of maxillofacial surgery in the database occurred at a rural hospital. The mean total hospital charge for these patients was $61,157.47 (interquartile range: $33,099.62 - $72,180.56). Hospitalization charges also increased significantly in this time period (p = 0.042), in conjunction with an average hospital length of stay of 2.54 days that did not change significantly during the study period (p = 0.693). CONCLUSION: Oral and maxillofacial procedures for patients with cleft lip and palate appear to be utilized mainly at larger, urban teaching and non-profit private hospitals and very rarely at rural hospitals. While hospital length of stay and procedure volume appears be stable year to year within the study period, hospitalization charges associated with the procedures rose significantly throughout. Further studies are necessary to examine other factors that could be contributing to the increasing hospitalization charges.


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