title: Office-based dental rehabilitation in children with special healthcare needs using a pediatric sedation service model.
abstract: OBJECTIVE
  1) To review our experience with office-based sedation/anesthesia for children with special healthcare needs who underwent dental rehabilitation at our institution. 2) To compare the cost to comparable patients who underwent similar procedures in the operating room.
  
  
  METHODS
  Retrospective review of patients' medical records and the sedation service database. Group CL: 114 patients who underwent office-based dental rehabilitation (135 procedures). Group OR: 23 patients who underwent dental rehabilitation under general anesthesia in the operating room for cost comparison.
  
  
  RESULTS
  1) EFFICACY (procedure completion rate and unplanned admissions); 2) SAFETY (complications and interventions); 3) Comparison of mean hospital charges billed between groups.
  
  
  RESULTS
  Demographics were similar in both groups. The most common specific underlying diagnoses were autism (38%), cerebral palsy/developmental delay (18%) and ADHD (4%) in both groups.
  
  
  RESULTS
  procedure completion rate was 98.5% (2 aborted). There was 1 (0.7%) unplanned postanesthetic care unit admission due to an adverse drug event.
  
  
  RESULTS
  2 (1.5%) patients required invasive airway control. Eighteen (13.3%) patients developed transient hypoxemia. Twenty-three (17%) patients had airway obstruction needing simple intervention, and 1 (0.7%) patient had hypotension. There were no serious complications. Cost: mean total hospital charges were considerably higher in group OR ($6,126), versus group CL ($1,277), even after adjustment for inflation and length of procedure (P<.0001).
  
  
  CONCLUSIONS
  Office-based dental rehabilitation using a pediatric sedation service model in children with special needs is efficient, and can achieve average savings of $4,849 in hospital charges per patient.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR 97239, USA. lalwanik@ohsu.edu
authors.forename: Kirk
authors.initials: K
authors.lastname: Lalwani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kitchin
authors.forename: Peter
authors.initials: P
authors.lastname: Lax
mesh_terms: D000766:Anesthesia, Dental / Q000191:economics* / Q000379:methods; D000768:Anesthesia, General / Q000191:economics; D002648:Child; D016292:Procedural Sedation / Q000191:economics; D017046:Cost Savings; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D019140:Dental Care for Children / Q000191:economics*; D003730:Dental Care for Persons with Disabilities / Q000191:economics*; D003793:Dental Restoration, Permanent / Q000191:economics*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009819:Office Visits / Q000191:economics*; D009873:Operating Rooms / Q000191:economics*; D012189:Retrospective Studies