Outcomes in Patients Hospitalized for Periapical Abscess in the United States An Analysis Involving the Use of a Nationwide Inpatient Sample
Department of Developmental Biology, School of Dental Medicine, Harvard University, 188 Longwood Ave., Boston, Mass. 02115, USA. Journal of the American Dental Association (1939)
(Impact Factor: 2.01).
09/2010; 141(9):1107-16. DOI: 10.14219/jada.archive.2010.0341
Severe infections resulting from periapical abscesses may warrant hospitalization. The authors conducted a study to investigate the factors affecting outcomes for patients hospitalized for periapical abscess in the United States in 2007.
The authors used the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for 2007. They selected for analysis all hospitalizations attributed primarily to periapical abscess. Outcomes examined included hospitalization charges, length of stay and type of admission (emergency or urgent versus elective). They used multivariable regression analysis to examine the effects of patient-related factors (including age, sex, presence of comorbid conditions, insurance status, type of periapical abscess and discharge disposition) on outcomes.
In 2007, 7,886 hospitalizations were attributed primarily to periapical abscess. Total hospital charges were $105.8 million. Periapical abscess also resulted in a total of 23,001 hospitalization days. The mean hospitalization charges and length of stay were $13,590 and 2.92 days, respectively. The authors found an association between patients with comorbid conditions and higher charges and longer length of stay (P < .05). Of all hospitalizations, 91 percent occurred on an emergency or urgent basis. The percentage was significantly higher among uninsured patients than among those with private insurance (P < .05).
The study provides nationally representative estimates of outcomes associated with hospitalizations due to periapical abscess, and it highlights the substantial resources needed to treat patients hospitalized for this condition.
Available from: Ashraf F Fouad
- "The infection can spread to cause mediastinitis [6,7], fatal necrotizing fasciitis  or brain abscess . In 2007, 7,886 hospitalizations were attributed to periapical abscesses . "
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ABSTRACT: Endodontic infections are a leading cause of oro-facial pain and tooth loss in western countries, and may lead to severe life-threatening infections. These infections are polymicrobial with high bacterial diversity. Understanding the spatial transition of microbiota from normal oral cavities through the infected root canal to the acute periapical abscess can improve our knowledge of the pathogenesis of endodontic infections and lead to more effective treatment. We obtained samples from the oral cavity, infected root canal and periapical abscess of 8 patients (5 with localized and 3 with systemic infections). Microbial populations in these samples were analyzed using next-generation sequencing of 16S rRNA amplicons. Bioinformatics tools and statistical tests with rigorous criteria were used to elucidate the spatial transition of the microbiota from normal to diseased sites.
On average, 10,000 partial 16S rRNA gene sequences were obtained from each sample. All sequences fell into 11 different bacterial phyla. The microbial diversity in root canal and abscess samples was significantly lower than in the oral samples. Streptococcus was the most abundant genus in oral cavities while Prevotella and Fusobacterium were most abundant in diseased samples. The microbiota community structures of root canal and abscess samples were, however, more similar to each other than to the oral cavity microbiota. Using rigorous criteria and novel bioinformatics tools, we found that Granulicatella adiacens, Eubacterium yurii, Prevotella melaninogenica, Prevotella salivae, Streptococcus mitis, and Atopobium rimae were over-represented in diseased samples.
We used a novel approach and high-throughput methodologies to characterize the microbiota associated normal and diseased oral sites in the same individuals.
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ABSTRACT: Dental conditions that are neglected could progress to infectious lesions that are severe enough to require hospital admission for treatment. The objective of this study was to examine outcomes in patients hospitalized for cellulitis and abscesses of mouth in the USA in year 2008.
The nationwide inpatient sample for the year 2008, a component database of the Healthcare Cost and Utilization Project, was used for the current study. All hospital discharges with a primary diagnosis for cellulitis or abscess of mouth (ICD-9-CM code 528.3) were selected for analysis. Outcomes, including length of stay in hospital (LOS) and hospitalization charges, were computed from the database and projected to national levels by using the discharge weight variable. The predictor variables were composed of sets of heterogeneous variables grouped into the following categories: demographic, health-related (comorbid conditions), hospital-specific, and insurance-related. The primary outcome variables were LOS and hospital charges. Multivariable linear regression analysis models were used to examine the association between predictor and outcome variables.
A total of 4,044 hospital discharges were attributed primarily to cellulitis or abscess of mouth. About 45% of these discharges occurred in those aged between 18 and 45 years. The mean length of stay in hospital was 3.9 days, and the mean hospital charge was $24,290. The total USA hospitalization charge was close to $98 million. Private insurance plans were the major payers, accounting for $31 million of hospitalization charges. About 88% of all hospitalization were discharged routinely after treatment, and 2% were transfered to another short-term hospital.
This study examines outcomes in patients hospitalized for cellulitis or abscess of mouth. Future studies must focus on identifying cohorts that are more prone to developing odontogenic infections that are severe enough to warrant hospitalization.
Available from: scindeks-clanci.ceon.rs
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