Skull Base Osteomyelitis: The Effect of Comorbid Disease on Hospitalization

Objectives/Hypothesis: Skull base osteomyelitis is a rare disease that has a high morbidity and mortality rate if diagnosis and treatment are delayed. Our objective was to perform a more detailed analysis of skull base osteomyelitis in the inpatient population. We also provide a more comprehensive evaluation of comorbid disease and severity of illness in this population and describe their effects on the duration and cost of hospital stay. Study Design: Review of the California Hospital Discharge Database between the years 1990 and 2000. Methods: Information evaluated included age, race, insurance, charges and length of hospital stay, comorbid disease, severity of illness, and disposition. Data were analyzed using analysis of variance and linear regression analysis. Results: The overall incidence of skull base osteomyelitis ranged from 57 to 95 cases annually (median 75.5). Whites (69.3%) were more likely to present with the disease than Native Americans (13.2%), African Americans (6.5%), or Asians (2.9%). The majority of patients diagnosed with skull base osteomyelitis had Medicare or public assistance (62%) compared with those with Preferred Provider Organization or Health Maintenance Organization insurance (27%). Increased length of hospital stay and increased charges incurred during hospitalization were significantly associated (P < .05) with aplastic anemia, renal disease, arteriosclerosis, facial nerve dysfunction, and diabetes. Severity of illness and the presence of one or more comorbid conditions also significantly affected the duration and charges incurred during hospital stay (P < .05). Conclusions: The presence of concurrent illness with skull base osteomyelitis significantly affects the duration of hospital stay and the charges incurred during hospitalization.