title: Tracheostomy versus mandibular distraction osteogenesis in infants with Robin sequence: a comparative cost analysis.
abstract: Many treatments have been described for infants with Robin sequence and severe respiratory distress, but there have not been many comparative studies of outcome and cost-effectiveness. The aim of this study was to compare the cost and complications of two common interventions - mandibular distraction osteogenesis and tracheostomy. Nine patients with isolated Robin sequence (mandibular distraction osteogenesis, n=5, and tracheostomy, n=4) were included in the analyses. Predetermined costs and complications were obtained retrospectively from medical records and by questionnaires to the parents over a 12-month period. Overall direct costs (admission to hospital, diagnostics, surgery, and homecare) were 3 times higher for tracheostomy (€105.523 compared with €33.482, p=0.02). Overall indirect costs (absence from work) were almost 5 times higher (€2.543 compared with €543, p=0.02). There was a threefold increase in overall total cost/patient (both direct and indirect) for tracheostomy (€108.057 compared with 34.016, p=0.02) and 4 times more complications were encountered. This study shows that mandibular distraction osteogenesis in infants diagnosed with Robin sequence costs significantly less and results in fewer complications than tracheostomy, and this contributes to our current knowledge about the ideal approach for infants with Robin sequence and might provide a basis for institutional protocols in the future.
authors.affiliation: Department of Pediatric Plastic Surgery at the Wilhelmina Children's Hospital, Utrecht, The Netherlands. Electronic address: emmapaes@gmail.com.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Paes
authors.affiliation: Department of Pediatric Plastic Surgery at the Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: James J
authors.initials: JJ
authors.lastname: Fouché
authors.affiliation: Department of Cranio-Maxillofacial Surgery at the Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Marvick S M
authors.initials: MS
authors.lastname: Muradin
authors.affiliation: Department of Otorhinolaryngology at the Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Lucienne
authors.initials: L
authors.lastname: Speleman
authors.affiliation: Department of Pediatric Plastic Surgery at the Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
authors.affiliation: Department of Pediatric Plastic Surgery at the Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D000041:Absenteeism; D000359:Aftercare / Q000191:economics; D000553:Ambulatory Care / Q000191:economics; D019411:Clinical Laboratory Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000191:economics; D007231:Infant, Newborn; D008334:Mandible / Q000601:surgery*; D008505:Medical Staff, Hospital / Q000191:economics; D019857:Osteogenesis, Distraction / Q000191:economics*; D010343:Patient Admission / Q000191:economics; D010855:Pierre Robin Syndrome / Q000191:economics / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D014139:Tracheostomy / Q000191:economics*; D016896:Treatment Outcome
keywords: (Pierre) Robin sequence; Cost analyses; Mandibular distraction osteogenesis; Tracheostomy; Treatment