Comparative Analysis of Hospital Charges in Infants With Robin Sequence: Nonsurgical Orthodontic Airway Plate Versus Surgical Mandibular Distraction

Abstract

Objective

To compare hospital charges associated with 2 airway treatments in infants with Robin sequence (RS)

Design

Retrospective cohort study.

Setting

Single quaternary pediatric hospital.

Patients

Infants with RS admitted for treatment between January 2016 and April 2023

Interventions

Nonsurgical Stanford orthodontic airway plate (OAP) or surgical mandibular distraction osteogenesis (MDO)

Main Outcome Measures

Hospital charges from admission to discharge, categorized and inflation-adjusted to 2024 United States Dollars

Results

Thirteen OAP-treated and nine MDO-treated infants were included. All infants were discharged home. Median age (minimum, maximum) at index admission was 38 days (1, 89) in OAP and 18 days (1, 65) in MDO. Median total hospital stay was 15 days (8, 26) in OAP and 23 days (12, 40) in MDO (P = 0.003). This included intensive care unit (ICU) stays of 3 days (0, 6) in OAP and 14 days (4, 21) in MDO (P < 0.001). Median total inflation-adjusted hospital charges were significantly lower in OAP ($683,549.20; interquartile range (IQR): $567,075.90 - $821,018.30) compared to MDO ($1,269,670.00; IQR: $932,087.50 - $1,573,712.00; P = 0.006), representing a 46.2% reduction. Non-ICU stay, ICU stay, and professional services were the top three contributors to the total hospital charges in OAP, while ICU stay, non-ICU stay, and operating room utilization were those in MDO during index admission.

Conclusions

Nonsurgical OAP has the potential to reduce hospital charges and accelerate the transition home compared to MDO, serving as a high-value treatment modality for optimizing both clinical outcomes and hospital resource allocation.