Outcomes of hospitalizations attributed to periapical abscess from 2000 to 2008: a longitudinal trend analysis

By Shah A, Leong K, Lee M, Allareddy V

Date: 01/2013
Journal: JOE


To study associations between patient characteristics and hospitalization outcomes


Data source: Nationwide Inpatient Sample (NIS) – collects data on US hospitalizations

Inclusion criteria: any patient billed out for a periapical abscess or periapical abscess + sinus involvement.

Variables examined: hospital charges, length of stay (days), age, sex, race, insurance status, comorbid burden severity, geographic region, hospital bed size, teaching status of hospital.

Study duration: 2000 – 2008


  • 61,439 hospitalization due to periapical abscess bw 2000-2008.
  • Sinus involvement: 3.2% of all cases.
  • Pt demographics – mean age = 37yo. 51% female. Race: white (61%), black (20%), Hispanics (13.5%), Asian (1.5%), Native Americans (0.5%).
  • Hospital demographics- region: South (40%), Midwest (25%), Northeast (20%), West (18%). Urban areas (85%). Mean hospital stay = 3 days.
  • 90% admitted as an emergency/urgent status. 66 patients died in the hospital.
  • Associations with hospital charges: ↑ cost due to: ↑ age, non-white, presence of sinus involvement, non-teaching hospital, non-West region, co-morbidities.
  • Associations with length of hospital stay: ↑ duration due to: ↑ age, non-white, Medicare or Medicaid insurance, present of sinus involvement, South region, large hospital, co-morbidities.
  • Trends (comparing overall data to 2000 data):
  • 40% increase in hospitalizations for periapical abscess.
  • Increase in billing to Medicare (33%), Medicaid (75%), private insurance (20%), self-pay (42%). Medicaid + Medicare paid 44% of all periapical abscess hospitalizations.
  • Taking into inflation, charges for hospital stay increased 99% from $66.3 million to $132 million. Charges per patient rose 36% from $12,158 to $16,521.

Clinical Significance:

Use of emergency services for periapical abscesses are a HUGE economic burden. Mean cost of root canal = $1112. Mean cost of extraction = $259. Efforts need to be made to increase access to preventative & routine dental care.