Hospitalization Trends for Orbital Cellulitis in the Pediatric Population: 2003-2009

Abstract

Objectives:

Orbital cellulitis occurs primarily following sinusitis. This infection resides posterior to the orbital septum with inherent risk to the eye, cavernous sinus, meninges, and brain. Fortunately, complications remain rare due to the advent of antibiotics. Surgical drainage through orbitotomy or ethmoidectomy may occur. We aim to characterize the demographic stratification, surgical treatment variation, and cost and resource use related to orbital cellulitis over time.

Methods:

We queried the Kid Inpatient Database for 2003, 2006, and 2009, identifying all cases of International Classification of Disease, ninth revision, clinical modification (ICD-9-CM) codes 376.01, orbital cellulitis. Census data were used to calculate incidence. We used Statistical Analysis Software for our analysis. This study used a publically available, de-identified database allowing exemption from the Institutional Review Board.

Results:

From 2003 to 2009, the incidence remained stable (3.2 to 2.8/100000 population). Males made up 60% of cases (relative risk [RR] 1.18, 95% confidence interval [CI] 1.16-1.20). Children 0-4yo were 1.92 times more likely to be afflicted than other age groups (RR 1.92, 95%CI 1.87-1.96). Mean and median length of stay remained constant at 3 days. Orbitotomy was performed more frequently than ethmoidectomy (7.2% vs 1.3%, P < 00.1). Median total charges increased from $6225 to $10290.

Conclusions:

The number of cases and incidence of orbital cellulitis remained constant. Numbers of cases decreased with increasing age. Costs per hospitalization increased, but lengths of stay remained constant. Orbitotomy was performed more frequently than ethmoidectomy; however, both procedures were infrequent. This suggests most providers follow recommendations of conservative treatment with antibiotics.