Abstract
Objectives:
(1) Describe national trends in peritonsillar abscess (PTA) requiring endotracheal intubation (ETI). (2) Determine factors associated with ETI in patients with PTA.
Methods:
Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD-9 code: 475) and ETI (ICD-9 code: 96.04) in adult patients (age ≥18 years old). Descriptive statistics and multivariate regression modeling were employed to identify factors associated with ETI.
Results:
From 2003 to 2010, 90,941 (95% CI:86, 433-95, 449) admissions associated with a PTA were identified, of which 1357 (1.5%) underwent ETI. These patients had a higher prevalence of concurrently coded sepsis (7.3% vs 1.2%), severe sepsis (13.0% vs 0.2%), and death (7.9% vs 0.1%) compared with patients without ETI. Intubated patients were significantly (all P < .001) older (45 vs 34 years old), had a longer hospital stay (10.8 vs 2.4 days), and had more procedures (5.4 vs 0.9). Multivariate regression analysis displayed factors associated with intubation included age group 65 and older (odds ratio [OR] = 6.408, P < .001), transfer from another hospital (OR = 2.917, P = .029), alcohol abuse (OR = 6.445, P < .001), anemia (OR = 2.957, P = .002), and obesity (OR = 3.301, P < .001). When controlling for age, sex, hospital characteristics, and number of procedures, general linear modeling demonstrated intubation accounted for $24,374 (P < .001) in excess total charges per patient. Overall charges for admissions with ETI accounted for $123 million over the study period.
Conclusions:
Patients with PTA undergoing ETI have worse in-hospital outcomes along with higher hospital charges. This study identifies characteristics of a PTA patient in whom clinicians should be wary of respiratory decompensation.
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