National Trends in Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess. (April 2015)

• Record Type: Journal Article
• Authors: Qureshi, Hannan A.; Ference, Elisabeth H.; Tan, Bruce K.; Chandra, Rakesh K.; Kern, Robert C.; Smith, Stephanie Shintani
• Is Part Of: Otolaryngology--head and neck surgery. Volume 152:Number 4(2015:Apr.)
• Page Start: 661
• Page End: 666
• Publication Date: 2015-04
• Subjects: peritonsillar abscess -- retropharyngeal abscess -- Healthcare Cost and Utilization Project -- Nationwide Inpatient Sample; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599814568286
• Languages: English
• ISSNs: 0194-5998

Abstract

Objectives: To describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA) and to determine factors associated with RPA in patients with PTA. Study Design: Cross-sectional analysis. Setting: Nationwide Inpatient Sample, 2003-2010. Subjects and Methods: PTA patients ≥18 years old, with or without RPA, were extracted according to ICD-9-CM codes. The cohort was analyzed with descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Results: Of the 91, 647 (95% CI: 86, 433-95, 449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA increased from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010 ( P < .001). PTA patients with RPA more frequently underwent tonsillectomy (23.5% vs 11.1%), endotracheal intubation (7.1% vs 1.5%), and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). PTA patients with RPA were significantly older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) when compared to patients without RPA (all P < .001). Upon multivariate regression analysis, factors associated with RPA included the age groups of 40 to 64 years (odds ratio, 2.256; P < .001) and 65 and older (odds ratio, 2.086; P = .045). Median total charges for PTA inpatients with concomitant RPA were approximately $8700 greater ( P < .001) when compared to patients with PTA alone. Conclusions: The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable prevention or earlier identification.