title: Time and cost analysis: pediatric dental rehabilitation with general anesthesia in the office and the hospital settings.
abstract: Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.
authors.affiliation: Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rashewsky
authors.forename: Ashish
authors.initials: A
authors.lastname: Parameswaran
authors.forename: Carole
authors.initials: C
authors.lastname: Sloane
authors.forename: Fred
authors.initials: F
authors.lastname: Ferguson
authors.forename: Ralph
authors.initials: R
authors.lastname: Epstein
mesh_terms: D000768:Anesthesia, General / Q000191:economics*; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000191:economics*; D003796:Dental Service, Hospital / Q000191:economics*; D006801:Humans; D009065:Mouth Rehabilitation / Q000191:economics*; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors