SA3 - Is Insurance Payer Associated With Hospital Admission of Emergency Department Patients With Odontogenic Infections?

Abstract: Statement of the problem: Patients who present to the emergency department (ED) with severe odontogenic infections are often admitted to the hospital.¹ While medical indications for admission are well-understood,¹ it remains unclear whether socioeconomic factors influence ED triage decisions, a phenomenon described in other areas of healthcare.² The purpose of this study was to investigate whether patient primary insurance payer was associated with admission and produce nationally representative estimates of the incidence and costs of hospital admission for patients with odontogenic infections.

Materials and

Methods: This was a retrospective cohort study using the 2018 National Emergency Department Sample (NEDS). Patients with odontogenic infections were identified based on International Classification of Diseases 10th revision (ICD-10) codes. The primary predictor variable was primary insurance payer, categorized as private insurance, Medicare, Medicaid, self-pay, and other. The primary outcome variable was hospital admission (yes or no). Covariates included sociodemographic, medical, and hospital characteristics. Descriptive statistics were calculated for all variables. Bivariate and multivariable logistic regression analyses were utilized to evaluate the association between study variables and hospital admission. Odds ratios (OR) and associated 95% confidence intervals (CI) were computed. Discharge weights were accounted for in all analyses to provide nationally representative estimates.

Results: A total of 26,950 subjects with odontogenic infections were included in this study. Of this cohort, 7,707 subjects (28.6%) were admitted. Regarding primary payer, 24.8% had private insurance, 15.9% had Medicare, 31.8% had Medicaid, 24.5% had self-pay, and 3.1% had other. The multivariable regression model showed that self-pay subjects had a significantly lower odds of hospital admission compared to those with private insurance (OR, 0.55; 95% CI, 0.44-0.68). Other notable factors independently associated with hospital admission were female sex (OR, 1.20; 95% CI, 1.06-1.37), infection in more than one location based on ICD-10 code (OR, 5.61; 95% CI, 3.68-8.55), higher Charlson comorbidity index (OR, 1.49; 95% CI, 1.39-1.60), alcohol use disorder (OR, 5.07; 95% CI, 3.11-8.28), and substance use disorder (OR, 1.70; 95% CI, 1.45-1.98). The mean ED charge for a subject with an odontogenic infection was $5,010 ± 223 for a total annual nationwide charge of $112,770,990.

Conclusions: Approximately 28.6% of subjects presenting to the ED with an odontogenic infection were admitted. Uninsured subjects had lower adjusted odds of hospital admission compared to those with private insurance. This finding is consistent with observations in other realms of healthcare and identifies potential disparities in patient triage that warrant further investigation.

References:
1. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, Trieger N: Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg 64: 1093, 2006.
2. Delgado MK, Yokell MA, Staudenmayer KL, Spain DA, Hernandez-Boussard T, Wang NE: Factors associated with the disposition of severely injured patients initially seen at non--trauma center emergency departments: disparities by insurance status. JAMA Surg 149: 422, 2014.