A. Gupta1, E. B. Schneider2 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Ohio State University,College Of Medicine,Columbus, OH, USA
Introduction:
Multiple surgical complications can be associated with dental extraction, such as excessive bleeding, bone sequestration, dry socket, numbness, swelling and trismus. Recent data from several countries demonstrates an increase in hospital based tooth extractions. In this study, using Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS), we describe the characteristics of patients, and associated charges with visits for tooth extraction in an in-patient and Emergency Department (ED) settings.
Methods:
All records with an ICD-9 procedure code for tooth extraction (23.0, 23.1, 23.11 and 23.19) were retrieved from NIS and NEDS databases from 2012 to 2014. Using the survey sampling methods for NIS and NEDS, descriptive statistics were used to report the weighted results. Charges were converted to 2014 US dollars.
Results:
Weighted to represent the national population, total hospital admissions and ED visits for tooth extraction were 40,270 and 1,341 respectively. Mean charge per visit for visits with extraction as the primary procedure was $43,372 (±1518) in an in-patient setting and $10,372 (±1069.17) in ED setting, representing total 3-year charges of $385 and $6 million respectively. The three most common primary diagnosis for both in-patient (27.6%) and ED visits (38.5%) were Peri-apical abscess without sinus, cellulitis and abscess of face and cellulitis/abscess of mouth. Mean inpatient LOS with extraction as the primary procedure was 5.6 (±0.31) days. >60% patients were below median income quartile in each setting, and 27.0% and 24.8% were Medicaid insured in in-patient and ED respectively. In the in-patient setting, 1.6% were <6 years of age and 13.7% were >65 years of age; while in the ED, 12.7% were <6 years of age and 4.2% were >65 years of age. Among those who received tooth extraction as the primary procedure, 44.4% had ≥ 1 comorbidity in the in-patient setting, and 13.6% in the ED.
Conclusion:
Hospital-level tooth extractions account for substantial charges and are commonly due to dental conditions that might be preventable/restorable in early stages, with regular access to dental care. Patients undergoing tooth extraction, particularly in the in-patient setting, were more likely to be elderly and to have comorbidities. Dental caries, often the cause of periapical abscess and which may progress to cellulitis, can usually be managed through restorative procedures in a dental setting. Given the cost and resources required to manage these conditions in a hospital/ED setting, improved access to preventative and restorative dental care might particularly benefit identifiable high-risk individuals. Further research on policies to improve access to preventative dental care for individuals at risk for emergent extraction might identify and provide cost-effective opportunities for reducing the incidence of hospital based tooth extractions.