J Korean Assoc Oral Maxillofac Surg.  2021 Jun;47(3):197-208. 10.5125/jkaoms.2021.47.3.197.

Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center

• Kim HW
• Kim CH

• KMID: 2517270
• DOI: http://doi.org/10.5125/jkaoms.2021.47.3.197

Abstract

Objectives
The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea.
Materials and Methods
A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses.
Results
Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis.
Conclusion
For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

Keyword

Abscess; Bacterial infections; Retropharyngeal abscess; Maxillofacial surgery; Antibiotics

Reference

References

1. Abramowicz S, Rampa S, Allareddy V, Lee MK. 2017; The burden of facial cellulitis leading to inpatient hospitalization. J Oral Maxillofac Surg. 75:1656–67. https://doi.org/10.1016/j.joms.2017.01.032 . DOI: 10.1016/j.joms.2017.01.032. PMID: 28242238.

2. Eisler L, Wearda K, Romatoski K, Odland RM. 2013; Morbidity and cost of odontogenic infections. Otolaryngol Head Neck Surg. 149:84–8. https://doi.org/10.1177/0194599813485210 . DOI: 10.1177/0194599813485210. PMID: 23585157.

3. Christensen B, Han M, Dillon JK. 2013; The cause of cost in the management of odontogenic infections 2: multivariate outcome analyses. J Oral Maxillofac Surg. 71:2068–76. https://doi.org/10.1016/j.joms.2013.05.027 . DOI: 10.1016/j.joms.2013.05.027. PMID: 23945517.

4. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, Trieger N. 2006; Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg. 64:1093–103. https://doi.org/10.1016/j.joms.2006.03.015 . DOI: 10.1016/j.joms.2006.03.015. PMID: 16781343.

5. Gams K, Shewale J, Demian N, Khalil K, Banki F. 2017; Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX. J Am Dent Assoc. 148:221–9. https://doi.org/10.1016/j.adaj.2016.11.033 . DOI: 10.1016/j.adaj.2016.11.033. PMID: 28129825.

6. Ahmad N, Abubaker AO, Laskin DM, Steffen D. 2013; The financial burden of hospitalization associated with odontogenic infections. J Oral Maxillofac Surg. 71:656–8. https://doi.org/10.1016/j.joms.2012.11.024 . DOI: 10.1016/j.joms.2012.11.024. PMID: 23385164.

7. Hurley RH, Douglas CM, Montgomery J, Clark LJ. 2018; The hidden cost of deep neck space infections. Ann R Coll Surg Engl. 100:129–34. https://doi.org/10.1308/rcsann.2017.0193 . DOI: 10.1308/rcsann.2017.0193. PMID: 29046089. PMCID: PMC5838695.

8. Allareddy V, Rampa S, Nalliah RP, Allareddy V. 2014; Longitudinal discharge trends and outcomes after hospitalization for mouth cellulitis and Ludwig angina. Oral Surg Oral Med Oral Pathol Oral Radiol. 118:524–31. https://doi.org/10.1016/j.oooo.2014.06.003 . DOI: 10.1016/j.oooo.2014.06.003. PMID: 25216950.

9. Jundt JS, Gutta R. 2012; Characteristics and cost impact of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol. 114:558–66. https://doi.org/10.1016/j.oooo.2011.10.044 . DOI: 10.1016/j.oooo.2011.10.044. PMID: 22819453.

10. Shah AC, Leong KK, Lee MK, Allareddy V. 2013; Outcomes of hospitalizations attributed to periapical abscess from 2000 to 2008: a longitudinal trend analysis. J Endod. 39:1104–10. https://doi.org/10.1016/j.joen.2013.04.042 . DOI: 10.1016/j.joen.2013.04.042. PMID: 23953280.

11. Kim MK, Allareddy V, Nalliah RP, Kim JE, Allareddy V. 2012; Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample. Oral Surg Oral Med Oral Pathol Oral Radiol. 114:312–7. https://doi.org/10.1016/j.tripleo.2011.07.043 . DOI: 10.1016/j.tripleo.2011.07.043. PMID: 22883981.

12. Kim MK, Nalliah RP, Lee MK, Allareddy V. 2012; Factors associated with length of stay and hospital charges for patients hospitalized with mouth cellulitis. Oral Surg Oral Med Oral Pathol Oral Radiol. 113:21–8. https://doi.org/10.1016/j.tripleo.2011.01.012 . DOI: 10.1016/j.tripleo.2011.01.012. PMID: 22677688.

13. Jansisyanont P, Kasemsai W, Bamroong P. 2015; Factors related to the treatment outcome of maxillofacial fascia space infection. J Oral Maxillofac Surg Med Pathol. 27:458–64. https://doi.org/10.1016/j.ajoms.2014.04.009 .

14. Zhang C, Tang Y, Zheng M, Yang J, Zhu G, Zhou H, et al. 2010; Maxillofacial space infection experience in West China: a retrospective study of 212 cases. Int J Infect Dis. 14:e414–7. https://doi.org/10.1016/j.ijid.2009.08.002 . DOI: 10.1016/j.ijid.2009.08.002. PMID: 19889560.

15. Mathew GC, Ranganathan LK, Gandhi S, Jacob ME, Singh I, Solanki M, et al. 2012; Odontogenic maxillofacial space infections at a tertiary care center in North India: a five-year retrospective study. Int J Infect Dis. 16:e296–302. https://doi.org/10.1016/j.ijid.2011.12.014 . DOI: 10.1016/j.ijid.2011.12.014. PMID: 22365137.

16. Yew CC, Ng MP, Ling XF, Tew MM. 2021; Orofacial infection and influencing factors on prolonged hospital stay: a four year retrospective study of 207 cases. J Oral Maxillofac Surg Med Pathol. 33:7–12. https://doi.org/10.1016/j.ajoms.2020.06.007 . DOI: 10.1016/j.ajoms.2020.06.007.

17. Park J, Lee JY, Hwang DS, Kim YD, Shin SH, Kim UK, et al. 2019; A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward. Maxillofac Plast Reconstr Surg. 41:49. https://doi.org/10.1186/s40902-019-0238-9 . DOI: 10.1186/s40902-019-0238-9. PMID: 31815113. PMCID: PMC6872703.

18. Agarwal AK, Sethi A, Sethi D, Mrig S, Chopra S. 2007; Role of socioeconomic factors in deep neck abscess: a prospective study of 120 patients. Br J Oral Maxillofac Surg. 45:553–5. https://doi.org/10.1016/j.bjoms.2007.01.001 . DOI: 10.1016/j.bjoms.2007.01.001. PMID: 17306911.

19. OECD. 2019. Health at a glance 2019: OECD indicators. OECD Publishing;Paris:

20. Zheng L, Yang C, Zhang W, Cai X, Kim E, Jiang B, et al. 2012; Is there association between severe multispace infections of the oral maxillofacial region and diabetes mellitus? J Oral Maxillofac Surg. 70:1565–72. https://doi.org/10.1016/j.joms.2011.07.010 . DOI: 10.1016/j.joms.2011.07.010. PMID: 22014938.

21. Jang JW, Kim CH, Kim MY. 2015; Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients. J Korean Assoc Oral Maxillofac Surg. 41:251–8. https://doi.org/10.5125/jkaoms.2015.41.5.251 . DOI: 10.5125/jkaoms.2015.41.5.251. PMID: 26568927. PMCID: PMC4641216.

22. Kang SK, Lee S, Oh HK, Kang MW, Na MH, Yu JH, et al. 2012; Clinical features of deep neck infections and predisposing factors for mediastinal extension. Korean J Thorac Cardiovasc Surg. 45:171–6. https://doi.org/10.5090/kjtcs.2012.45.3.171 . DOI: 10.5090/kjtcs.2012.45.3.171. PMID: 22708085. PMCID: PMC3373973.

23. Christensen B, Han M, Dillon JK. 2013; The cause of cost in the management of odontogenic infections 1: a demographic survey and multivariate analysis. J Oral Maxillofac Surg. 71:2058–67. https://doi.org/10.1016/j.joms.2013.05.026 . DOI: 10.1016/j.joms.2013.05.026. PMID: 23891018.

24. Sohn M, Jung M. 2016; Effects of public and private health insurance on medical service utilization in the National Health Insurance System: national panel study in the Republic of Korea. BMC Health Serv Res. 16:503. https://doi.org/10.1186/s12913-016-1746-2 . DOI: 10.1186/s12913-016-1746-2. PMID: 27654146. PMCID: PMC5031343.

25. Song YJ. 2009; The South Korean health care system. JMAJ. 52:206–9.

26. OECD. 2020. OECD Reviews of public health. OECD;Paris:

27. Kruger E, Tennant M. 2016; Socioeconomic disadvantage and oral-health-related hospital admissions: a 10-year analysis. BDJ Open. 2:16004. https://doi.org/10.1038/bdjopen.2016.4 . DOI: 10.1038/bdjopen.2016.4. PMID: 29607065. PMCID: PMC5842864.

28. Flynn TR, Shanti RM, Hayes C. 2006; Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg. 64:1104–13. https://doi.org/10.1016/j.joms.2006.03.031 . DOI: 10.1016/j.joms.2006.03.031. PMID: 16781344.