Factors and Economic Outcomes Associated with Documented Difficult Intubation in the United States

Abstract

Purpose Establishing good mechanical ventilation is a critical component and prerequisite to a wide range of surgical and medical interventions. Yet difficulties in intubating patients, and a variety of associated complications, are well documented. The economic burden resulting from difficult intubation (DI), however, is not well understood. The current study examines the economic burden of documented DI during inpatient surgical admissions and explores factors that are associated with DI. Patients and Methods Using data from the Premier Healthcare Database, adult patients with inpatient surgical admissions between January 1, 2016 and December 31, 2018 were selected. International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnosis codes were used to classify the patients into matched cohorts of DI and non-DI patients. Results Patients in the DI group have mean inpatient costs and intensive care unit (ICU) costs that are substantially higher than patients without difficult intubations ($14,468 and $4,029 higher, respectively). Mean hospital length of stay and ICU length of stay were 3.8 days and 2.0 days longer, respectively (all p<0.0001, except ICU cost p=0.0001) in the DI group. Obesity, other chronic conditions, and larger hospital size were significantly associated with DI. Conclusion DI is associated with higher average cost and longer average length of stay.

Endotracheal Intubation of Difficult Airways in Emergency Settings: A Guide for Innovators

“…While the LMA falls under similar parameters as the identified gap (albeit with a slightly higher cost range), an important consideration not analyzed in this landscape is the time duration in which the device can be deployed. A primary reason endotracheal tubes remain the gold standard for intubation is that LMAs have a recommended use time of approximately thirty minutes, with an upper limit of three hours 85 Therefore, LMAs should only be considered first-line devices if major surgery is not anticipated. While not a key performance indicator, any novel technology should have the capacity to maintain the airway during major procedures and not need to be replaced by an endotracheal tube.…”

“…The average admission cost for visits associated with intubating difficult airways is $20k higher than typical airways, at $33k and $13k, respectively. 29 , 85 , 95 Thus, while the market is crowded and conventional value gaps do not drive the opportunity, the difficult airway opportunity remains attractive to investors, users, and innovators. We provide a comprehensive review of intubation procedures, existing solutions, and disease states to guide future improvements.…”

A Decision Tree Approach to Airway Management Pathways in the 2022 Difficult Airway Algorithm of the American Society of Anesthesiologists

“…Recently, increased dollar costs associated with difficult tracheal intubation have been demonstrated. 17,18 Of those patients who are assessed to be appropriate for routine airway management after the induction of anesthesia, 3% to 13% may prove difficult to intubate. 14,19 As noted, this appears independent of whether direct or indirect laryngoscopy is used.…”

Implementation of video laryngoscopes and the development in airway management strategy and prevalence of difficult tracheal intubation: A national cohort study

“…17,18 Furthermore, emerging evidence suggests economic benefits transforming to routine use of video laryngoscope assisted intubation. 19,20 Theoretical contraindications for video laryngoscope assisted intubation are limited but may include limited mouth opening, considerable amounts of blood or secretions in the upper airway, limited thyromental distance, a short neck, and a large overbite. 21,22 The association over time between the anaesthesiologists' anticipated difficulties with airway management, choice of intubation strategy, and the use of the video laryngoscope is poorly described.…”

“…Some anaesthesia departments in the UK have completely replaced the Macintosh laryngoscope with the video laryngoscope 17,18 . Furthermore, emerging evidence suggests economic benefits transforming to routine use of video laryngoscope assisted intubation 19,20 . Theoretical contraindications for video laryngoscope assisted intubation are limited but may include limited mouth opening, considerable amounts of blood or secretions in the upper airway, limited thyromental distance, a short neck, and a large overbite 21,22 …”