(16) Obstructive Sleep Apnea in Young Adults Undergoing Orthognathic Surgery: Impact on Length of Stay and Hospital Admission Costs

Abstract:

Purpose: Length of hospital stay (LOS) significantly affects costs and is a frequently employed metric for quality of care. Obstructive sleep apnea (OSA) has been demonstrated to elevate the risk of postoperative complications and prolong LOS in patients undergoing orthognathic surgery. However, previous studies have predominantly focused on OSA patients amongst older adults and those with underlying comorbidities. A paucity of data exists regarding younger patients with OSA undergoing orthognathic surgery. This study aimed to examine the LOS and hospital costs in young patients with OSA undergoing orthognathic surgery.

Methods: Patients aged 14-20 undergoing orthognathic surgery from 2017-2019 were identified in the Healthcare Cost & Utilization Project Kids’ Inpatient Database (KID). The primary predictor variable was patients with a preoperative diagnosis of OSA. Median LOS and total hospital charges were then identified and used as cutoffs for our outcome variables of interest, which were prolonged LOS and higher total hospital admission costs. Descriptive and bivariate analyses were performed. Available pre-operative predictor variables noted to be significant on bivariate analysis (p < 0.05) were included in a final multivariate logistic regression model. Two separate multivariate models were developed to identify an independent association of OSA with extended postoperative LOS and increased total hospital admission costs.


Results: 2663 patients aged 14-20 undergoing orthognathic surgery were included in this study. 126 (4.73%) patients had a pre-operative diagnosis of OSA. Patients diagnosed with OSA had an average LOS of 2.27 days and total hospital charge of $112,925 compared to patients without OSA, who had an average LOS of 1.67 days and total hospital charge of $86,455. Bivariate analysis showed that patients with OSA were significantly more likely to have an extended LOS (p < 0.001) and higher total hospital charges (p=0.001). In multivariate analysis, OSA was independently associated with an extended LOS (OR 1.8, 95% CI 1.24-2.61, p= 0.002) and a higher-than-average cost of hospital admission (OR 1.73, 95% CI 1.17-2.55, p=0.006).

Conclusion: Using nationally reported data, young adults with OSA undergoing orthognathic surgery were shown to be independently associated with prolonged LOS. Subsequently, this patient population was also shown to have significantly higher total hospital admission charges. This study highlights the impact of OSA on healthcare utilization in young adults undergoing orthognathic surgery and reinforces the need to acknowledge the potential financial burden associated with this condition.

References:
Passeri, Luis A et al. “Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea.” Journal of oral and maxillofacial surgery vol. 74,10 (2016): 2033-43.
Dehlink, Eleonora, & Hui-Leng Tan. "Update on paediatric obstructive sleep apnoea." Journal of Thoracic Disease vol 8.2 (2016): 224-235.