Cost Analysis of Avoiding Gastrostomy Tube in Robin Sequence Neonates that Undergo Mandibular Distraction.

Abstract

To evaluate costs associated with perioperative gastrostomy tube (G-tube) placement for neonates with Robin sequence (PRS) that undergo mandibular distraction osteogenesis (MDO). Retrospective chart review was performed to examine the medical records of neonates with RS who received treatment at our institution between 2012 and 2021. Patients under 6 months of age that underwent MDO for RS were included. Billing records of hospital costs over a 2-year period were analyzed. The study included 26 total patients with 11 in the MDO-only group, 9 in G-tube after MDO group, and 6 in G-tube before MDO group. There was a significant difference (p < 0.001) in total hospital costs between groups with MDO-only group averaging $119,532 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 33,503), the G-tube after MDO group averaging $245,315 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 102,327), and G-tube before MDO group averaging $252,300 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 84,990). Multiple linear regression was performed controlling for genetic syndrome and birth weight, which still showed a statistically significant difference in total cost between the MDO-only group and G-tube after MDO (p = 0.006), and between the MDO-only group and G-tube prior to MDO (p = 0.01). There was a significant difference in costs between all three groups for total inpatient/outpatient costs with MDO-only group averaging $78,502 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 30,953), the G-tube after MDO group averaging $176,125 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 84,315), and the G-tube prior to MDO group averaging $156,309 (SD <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>±</mo></mrow> </math> 95,746). MDO performed without perioperative G-tube placement may reduce charges by >$100,000. The associated improvement of dysphagia after MDO surgery and potential for avoiding a G-tube has tremendous downstream cost and social benefits for families. NA Laryngoscope, 135:1192-1198, 2025.