Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: The aim of this study was to identify risk factors for high admission costs in patients undergoing surgery for odontoid fractures.
Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adults who underwent a surgical intervention for odontoid fracture were identified using ICD-10-CM codes. Patients were dichotomized by whether they experienced Normal Cost (NC) or an Exorbitant Cost (EC), defined as a total cost of admission greater than the 75th percentile cost for the cohort ($45,206). Patient demographics, comorbidities, treating hospital characteristics, intraoperative variables, postoperative adverse events (AE), and healthcare resource utilization were assessed. Multivariate logistic regression analysis was used to identify independent predictors of EC.
Results: Of the 9,850 patients identified, 2,465 (25.0%) were in the EC cohort. Age, income quartile, and healthcare coverage were similar between cohorts, though a greater proportion of patients in the EC cohort were male (p=0.005), non-White (p < 0.001), and treated at an urban teaching hospital (p=0.013). Comorbidity burden was greater in the EC cohort (p < 0.001). Patients in the EC cohort experienced higher rates of postoperative complications (p < 0.001). Patients in the EC cohort had significantly higher mean LOS (p < 0.001) and were more likely to undergo non-routine discharge (NC: 42.4% vs. EC: 68.6%, p< 0.001). On multivariate analysis, factors independently associated with EC included West hospital region [OR: 4.12, p< 0.001], having 1-2 comorbidities [OR: 1.82, p=0.043], experiencing ≥1 complication [(1 AE) OR: 1.57, p=0.006; (>1 AE) OR: 2.88, p< 0.001], and extended LOS [OR: 1.34, p< 0.001], though age [OR: 0.99, p< 0.001] and South hospital region [OR: 0.55, p=0.010] were inversely associated with EC.
Conclusion : We identified various patient- and hospital-risk factors for increased hospital costs in patients undergoing operative management of odontoid fractures.
