title: Cost analysis of mandibular distraction versus tracheostomy in neonates with Pierre Robin sequence.
abstract: OBJECTIVE
  To evaluate costs associated with surgical treatment for neonates with Pierre Robin sequence (PRS).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Cincinnati Children's Hospital Medical Center.
  
  
  METHODS
  With Institutional Review Board approval, we retrospectively studied neonates with PRS treated from 2001 to 2009 with either tracheostomy (Trach), mandibular distraction (MD), or Trach with subsequent MD (Trach+MD). Actual charges over a 3-year period associated with operative costs, hospital stay, imaging and sleep studies, clinic visits, and related emergency room visits were collected. Home tracheostomy care charges were estimated individually for each patient. Charges were compared using regression and appropriate statistical analyses.
  
  
  RESULTS
  Forty-seven neonates were included in the study (MD, n = 26; Trach, n = 12; Trach+MD, n = 9). Trach group patients had 2.6-fold higher charges than the MD group despite no difference in length of hospital stay. This difference increased to 7.3-fold when including home trach care-related costs. Trach+MD group patients had longer hospital lengths of stay and higher operation room (OR) fees, but no increased total charges compared with the Trach only group.
  
  
  CONCLUSIONS
  For patients with severe PRS, mandibular distraction provides significant cost savings over tracheostomy ($300,000 per patient over 3 years). Increased costs with tracheostomy come from greater hospital-related charges, more frequent airway procedures, a higher incidence of gastrostomy tube feeds, and home trach care costs. A careful examination of long-term outcomes will be critical as mandibular distraction continues to gain acceptance for treatment of PRS.
authors: Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA These authors contributed equally to this article chris.runyan@cchmc.org.
authors: Christopher M
authors: CM
authors: Runyan
authors: Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA These authors contributed equally to this article.
authors: Armando
authors: A
authors: Uribe-Rivera
authors: Kaiser Permanente Clinical Genetics Department, Oakland, California, USA.
authors: Audrey
authors: A
authors: Karlea
authors: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Jareen
authors: J
authors: Meinzen-Derr
authors: Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Dawn
authors: D
authors: Rothchild
authors: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Howard
authors: H
authors: Saal
authors: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA These authors contributed equally to this project.
authors: Robert J
authors: RJ
authors: Hopkin
authors: Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA These authors contributed equally to this project.
authors: Christopher B
authors: CB
authors: Gordon
mesh_terms: D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000002:abnormalities* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000191:economics*; D010855:Pierre Robin Syndrome / Q000191:economics* / Q000601:surgery*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000191:economics*
keywords: Pierre Robin sequence; mandibular distraction osteogenesis; tracheostomy