P0957 - Current Management Trends and Opportunities for Cost Savings in the Management of Spontaneous Pneumothorax

Purpose: In children and adolescents with a spontaneous pneumothorax, we hypothesize that avoiding procedural intervention can result in a shorter length of stay (LOS) and lower cost.

Methods: Using the Healthcare Cost and Utilization Project Kids’ Inpatient Database, all instances of spontaneous pneumothorax in 2016 were examined. Age, gender, cost and length of stay were compared using ANOVA and t-test comparisons.

Results: Of the 793 patients, aged 2-20, management consisted of observation, chest tube drainage, and surgical intervention(14.4% vs45.5% vs40.1%). There was no significant difference in the M:F ratio across the three groups(4.4 vs5.7 vs6.6), although the observation group appeared younger on average (16.4 vs17.6 vs17.3; p<0.01). Management strategies varied based on population density and race(p<0.05; table 1), but did not appear to vary based on income or insurance type. The observation group had the shortest LOS(2.26 vs4.09 vs6.76; p<0.01) and lowest cost($13480 vs$26719 vs$61860; p<0.01) while the surgical group was associated with the longest LOS and highest cost. The chest tube group fell in the middle, but 9.6% required additional intervention, which was associated with increased LOS(3.6 vs8.88, p<0.01) and cost($22886 vs$61747, p<0.01). Examining the surgical group for patients that had surgery within 24 hours of admission, there was a significant reduction in LOS(4.92 vs8.2; p<0.01) and cost($52446 vs$68882; p<0.01) as compared to the remainder of the group. The LOS for this group approached that of the chest tube group(4.08 vs4.92; p<0.01).

Conclusions: The most cost-effective management of spontaneous pneumothorax appears to be with observation alone and should be the preferred method when the patient’s condition allows. When a procedural intervention is necessary, surgery is associated with longer hospitalization and higher cost as compared to chest tube insertion. However, these differences can be partially offset by proceeding to surgery within 24 hours of admission.