Advertisement

Outcomes of Hospitalizations Attributed to Periapical Abscess from 2000 to 2008: A Longitudinal Trend Analysis

      Abstract

      Introduction

      Root canal therapy is a highly successful in-office treatment and preventive measure against periapical abscesses. Left untreated, periapical abscesses can have serious consequences that can lead to hospitalization. This study observes the trends of hospitalizations attributed to periapical abscesses.

      Methods

      A retrospective analysis of the Nationwide Inpatient Sample (years 2000–2008) was used; we selected cases with a primary diagnosis of a periapical abscess with/without sinus involvement. The demographic characteristics and outcomes were examined. Each individual hospitalization was the unit of analysis.

      Results

      During the 9-year study period, a total of 61,439 hospitalizations were primarily attributed to periapical abscesses in the United States. The average age was 37 years, and 89% of all hospitalizations occurred on an emergency/urgent basis. The mean length of stay was 2.96 days, and a total of 66 patients died in hospitals. Medicare, Medicaid, and private insurance plans paid for 18.7%, 25.2%, and 33.4% of hospitalizations, respectively. Uninsured patients accounted for 18.5% of hospitalizations. Significant predictors that influenced both hospital charges and length of stay included age, race, insurance status, a periapical abscess with sinus involvement, geographic region of country, the Charlson comorbidity index, and the year of study (P < .05).

      Conclusions

      The current study highlights the increasing burden of hospitalization of patients with periapical abscesses over a 9-year study period from 2000 to 2008. The high-risk groups likely to seek a hospital setting for the treatment of periapical abscesses were identified as were groups associated with higher hospital charges and a longer length of stay.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Clarke J.H.
        Toothaches and death.
        J Hist Dent. 1999; 47: 11-13
        • Ferrera P.C.
        • Busino L.J.
        • Snyder H.S.
        Uncommon complications of odontogenic infections.
        Am J Emerg Med. 1996; 14: 317-322
        • Flynn T.R.
        Surgical management of orofacial infections.
        Atlas Oral Maxillofac Surg Clin North Am. 2000; 8: 77-100
        • Flynn T.R.
        The swollen face: severe odontogenic infections.
        Emerg Med Clin North Am. 2000; 18: 481-519
        • Dahlén G.
        Microbiology and treatment of dental abscesses and periodontal-endodontic lesions.
        Periodontol 2000. 2002; 28: 206-239
        • Seppänen L.
        • Lauhio A.
        • Lindqvist C.
        • et al.
        Analysis of systemic and local odontogenic infection complications requiring hospital care.
        J Infect. 2008; 57: 116-122
        • Nalliah R.P.
        • Allareddy V.
        • Elangovan S.
        • et al.
        Hospital emergency department visits attributed to pulpal and periapical diseases in the United States in 2006.
        J Endod. 2010; 37: 6-9
        • Allareddy V.
        • Lin C.Y.
        • Shah A.
        • et al.
        J Am Dent Assoc. 2010; 141: 1107-1116
      1. Healthcare Cost and Utilization Project Databases. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/databases.jsp. Accessed May 6, 2012.

      2. Bureau of Labor Statistics. Consumer Price Index Detailed Reports. Available from: http://www.bls.gov/cpi/cpi_dr.htm. Accessed May 6, 2012.

        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
      3. American Dental Association, Health Policy Resources Center. 2009 Survey of Dental Fees. Available at: https://www.ada.org/members/sections/professionalResources/09_sdf.pdf. Accessed January 4, 2012.

        • Braveman P.A.
        • Egerter S.
        • Bennett T.
        • et al.
        Differences in hospital resource allocation among sick newborns according to insurance coverage.
        JAMA. 1991; 266: 3300-3308
        • Joyce G.F.
        • Goldman D.P.
        • Leibowitz A.
        • et al.
        Variation in inpatient resource use in the treatment of HIV.
        Med Care. 1999; 37: 220-227
        • Abdullah F.
        • Zhang Y.
        • Lardaro T.
        • et al.
        Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality.
        J Public Health. 2009; 32: 236-244
        • Hadley J.
        • Steinberg E.P.
        • Feder J.
        Comparison of uninsured and privately insured hospital patients.
        JAMA. 1991; 265: 374-379
      4. Stranges E, Kowlessar N, Davis H. Uninsured hospitalizations, 2008. Healthcare Cost and Utilization Project Statistical Brief 108. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb108.jsp. Accessed May 6, 2012.

        • Shen J.J.
        • Wan T.T.
        • Perlin J.B.
        An exploration of the complex relationships of socioecologic factors in the treatment and outcomes of acute myocardial infarction in disadvantaged populations.
        Health Serv Res. 2001; 36: 711-732
        • Meurer J.R.
        • Kuhn E.M.
        • George V.
        • et al.
        Charges for childhood asthma by hospital characteristics [serial online].
        Pediatrics. 1998; 102: E70
        • Mitchell J.M.
        Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?.
        Med Care. 2008; 46: 732-737
        • Hadley J.
        Sicker and poorer—the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income.
        Med Care Res Rev. 2003; 60: 3S-75S
        • Ayanian J.Z.
        • Weissman J.S.
        • Schneider E.C.
        • et al.
        Unmet health needs of uninsured adults in the United States.
        JAMA. 2000; 284: 2061-2069
        • Baker D.W.
        • Shapiro M.F.
        • Schur C.L.
        Health insurance and access to care for symptomatic conditions.
        Arch Intern Med. 2000; 160: 1269-1274
        • Trivedi A.N.
        • Zaslavsky A.M.
        • Schneider E.C.
        • et al.
        Trends in the quality of care and racial disparities in Medicare managed care.
        N Engl J Med. 2005; 353: 692-700
        • Roy L.C.
        • Torrez D.
        • Dale J.C.
        Ethnicity, traditional health beliefs, and health-seeking behavior: guardians' attitudes regarding their children's medical treatment.
        J Pediatr Health Care. 2004; 18: 22-29
        • Bloom B.
        • Gift H.C.
        • Jack S.S.
        Dental services and oral health.
        Vital Health Stat 10. 1992; 183: 1-95
        • Bloom B.
        • Cohen R.A.
        Dental Insurance for Persons Under Age 65 Years With Private Health Insurance: United States, 2008.
        (NCHS Data Brief, No 40) National Center for Health Statistics, Hyattsville, MD2010
        • Burnham R.
        • Bhandari R.
        • Bridle C.
        Changes in admission rates for spreading odontogenic infection resulting from changes in government policy about the dental schedule and remunerations.
        Br J Oral Maxillofac Surg. 2011; 49: 26-28