Hospital utilization for orbital and intracranial complications of pediatric acute rhinosinusitis.

BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, p < 0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], p < 0.001) but similar LOS (12 [10] v 11 [9] days, p = 0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.

Hospital cost of pediatric patients with complicated acute sinusitis.

OBJECTIVE: Review costs for pediatric patients with complicated acute sinusitis. METHODS: A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. RESULTS: The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. CONCLUSION: Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.

Socioeconomic disparities in the presentation of acute bacterial sinusitis complications in children.

OBJECTIVES/HYPOTHESIS: To identify characteristics and disparities associated with presentation of pediatric acute bacterial sinusitis (ABS) complications. STUDY DESIGN: A cross-sectional study of the 2008 Nationwide Emergency Department Sample database. METHODS: A total of 101,660 children 18 years of age or younger diagnosed with ABS, 696 of whom had orbital or intracranial complications, were identified. Patient and hospital-specific characteristics were investigated for association with childhood ABS complications. RESULTS: Orbital and intracranial complications occurred in 0.7% of children with ABS. Such complications were more common in boys (odds ratio [OR]: 1.65, P<.001) and children with chronic rhinosinusitis (OR: 7.89, P<.001), and were associated with presentation to metropolitan teaching (OR: 2.15, P<.001) and nonteaching (OR: 14.39, P<.001) hospitals. Orbital complications were associated with younger age (OR: 0.96, P<.001), whereas intracranial complications were associated with older age (OR: 1.11, P<.001). A dichotomy in socioeconomic background differentiated children with orbital ABS complications from those with intracranial complications. Although orbital complications were associated with higher income (OR: 2.13, P<.001) and private insurance (OR: 1.36, P=.003), intracranial complications were associated with Medicaid (OR: 2.96, P<.001) or no insurance at all (OR: 3.73, P=.001). CONCLUSIONS: Socioeconomic disparities exist in presentation of ABS complications in children. Although hinted at by the association with urban/metropolitan hospitals, explicit evidence is provided by association of intracranial complications with markers of low socioeconomic status and poor access to healthcare. Efforts to aid early diagnosis and treatment should target providers in metropolitan areas who treat children of lower socioeconomic status. Such interventions will ideally improve outcomes and limit healthcare costs related to the high morbidity of pediatric ABS complications. LEVEL OF EVIDENCE: 2b.

Aspiration or capsule excision? Analysis of treatment results for brain abscesses at single institute.

AIM: Aspiration of the abscess cavity versus excision of capsule are still in debate for the capsulated, large, superficially located abscesses. MATERIAL AND METHODS: Twenty patients who had large, solitary, capsulated, and superficially located lobar abscesses were analyzed retrospectively to compare the efficiency of two different surgical approaches and their impact on postoperative antibiotic use and the length of hospital stay. RESULTS: Nine patients underwent the capsule excision and 11 patients had the aspiration of their abscesses. There were no differences in terms of age, sex, location of abscesses, and radiographic features. There were 3 residual/recurrence in the aspiration group, who needed a second aspiration whereas; no residual/recurrence was observed in the excision group. Postoperative utilization of antibiotics was significantly less in the excision group (Mean: 26.7 days in the excision group vs. 46.6 days in aspiration group). Length of hospital stay for the purpose of iv antibiotic administration was significantly shorter in the excision group in close correlation with iv antibiotic use. CONCLUSION: Our study demonstrated that excision of abscess capsule was superior to aspiration in terms of efficiency of surgical intervention and postoperative cost of the treatment in a highly selected group of brain abscesses.