SA3 - Are Socioeconomic Factors Associated With Surgical Admissions for Odontogenic Infections?

Abstract: Healthcare disparity across socioeconomic groups in the United States is prevalent. While many public health studies and political reform focus on medicine, dentistry should not be trivialized. The American Dental Association estimates each year there are 2.2 million emergency room visits due to non-traumatic dental conditions (NTDC) with costs exceeding 2 billion dollars. These numbers are from national databases that identify specific ICD-10-CM codes such as dental caries, pulpitis, and acute periodontitis from all emergency room encounters. In addition, these studies distinguish the majority of these patients are female, uninsured, and/or on Medicaid. While these reports expose the socioeconomic groups that are most vulnerable to use an emergency room for dental care, there are no follow-up studies targeting the severity of visits that necessitate surgical intervention and extended hospital stays. Severe odontogenic infection cases are life-threatening, which require an emergent team of skilled oral and maxillofacial surgeons, anesthesiologists, nursing staff, and medical equipment. The Oral and Maxillofacial Surgery team at The Ohio State University Wexner Medical Center (OSUWMC) has seen a trend of severe dental infections from the emergency room that parallel national NTDC visits over the past 5 years. As Columbus is the 15th most populated city in the United States and the largest city in Ohio, and OSUWMC is the only central hospital in the state with an oral and maxillofacial surgery service, we feel this is an optimal patient dataset to follow and strengthen previous public health reports. This study is a retrospective and observational cohort analysis of surgical patients at a single academic medical center. Patients were identified electronically via the OSUWMC Information Warehouse and included all patients admitted to the Oral and Maxillofacial Surgery Service from the emergency room. All patients in this study had a surgical intervention for an odontogenic infection in the hospital operating room and required a minimum of 2 days post-surgical admission for management. Time points were July 1, 2017, to June 30, 2023. Pertinent data recorded was age, gender, American Society of Anesthesiology (ASA) classification of physical status, and insurance type. The internal dataset was compared to the state of Ohio annual published statistics detailing population size, age, gender, and insurance status for the entire population. We observed 195 of 361 (54.0%) of our patients had government insurance, compared to the 47.7% of Ohioans that have government insurance. Similar to national studies, our data showed the majority of the patients with government insurance were female with an average age of 44 (Table 1 and Graph 1). A chi-squared goodness-of-fit test that compares the breakdown of insurance type in our observed data to the 2023 statewide breakdown for Ohio returns a P-value of < .0001 (χ2 = 73.49, df = 2). Therefore, we claim that our patient population has a higher number of surgical admissions for odontogenic infections among the uninsured and government insured citizens in comparison to the rest of the Ohio population that is insured. Public health reports are critical to accentuate the inequality of access to care, which is the impetus for change. Previous studies focus on the burden of outpatient dental emergency care and costs, which has driven state legislatures to support general dentists to provide routine care for specific socioeconomic groups. Currently, there are no studies highlighting the role that oral and maxillofacial surgeons have with this healthcare crisis. Moving forward, the authors intend to broaden this preliminary data to emphasize the unreported costs of operating rooms and hospital beds, in addition to promote much needed collaboration between hospitals and oral and maxillofacial surgeons managing this unique patient population.

References: Giannouchos, T.V., Reynolds, J., Damiano, P. et al. Association of Medicaid expansion with dental emergency department visits overall and by states’ Medicaid dental benefits provision. BMC Health Serv Res 23, 625 (2023). https://doi.org/10.1186/s12913-023-09488-3Sun BC, Chi DL, Schwarz E, Milgrom P, Yagapen A, Malveau S, Chen Z, Chan B, Danner S, Owen E, Morton V, Lowe RA. Emergency department visits for nontraumatic dental problems: a mixed-methods study. Am J Public Health. 2015 May;105(5):947-55. doi: 10.2105/AJPH.2014.302398. Epub 2015 Mar 19. PMID: 25790415; PMCID: PMC4386544.

Table 1
Graph 1