Reasons for Failed General Anesthesia and Procedural Sedation of Pediatric Dental Procedures

Objectives: This study evaluated the reasons why pediatric dental patients missed their history and physical (H&P) or treatment appointments utilizing general anesthesia (GA)/procedural sedation (PS), and compared them to patients who kept their appointments.
Methods: Data were collected from a retrospective chart review of 176 patients who failed, late cancelled, or kept their GA, PS, or H&P appointments at the University of Iowa’s Pediatric Dental Clinic (UIPDC) between January 1, 2018-May 31, 2018. The information obtained included patients’ demographics and reasons why the patient failed their appointments. Statistical analyses consisted of descriptive and bivariate analyses using chi-square test, Fisher’s exact test, Cochran-Mantel-Haenszel test, and Wilcoxon rank-sum test (alpha=0.10).
Results: 176 subjects were included, 41 who failed appointments (mean age=8.54±7.13 years; 43.9% males) and 135 who kept appointments (mean age=8.98±8.71 years; 60% males). Of those who failed, 92.7% had Medicaid/DWP and 51.2% had special health care needs (SHCN), compared to those who kept appointments, 77% had Medicaid/DWP and 58.5% had SHCN. The most common reasons for failing appointments were reported as "child illness," followed by “other,” “unknown,” and "provider cancelled due to illness." Bivariate analysis revealed females versus males (29.9% vs. 18.2%; p=0.0688) and those that had Medicaid/DWP rather than private insurance (26.8% vs. 8.8%; p=0.0252) were more likely to fail appointments. Age, distance from where a patient lives to the UIPDC, and other clinical factors were not significantly associated with failing appointments (p>0.10 in each instance).
Conclusions: Important distinctions were found between patients who failed or late cancelled their appointments and who kept their appointments. Patients who had Medicaid/DWP were more likely to fail their appointments. The findings from this study can help the clinics create strategies to reduce these failures.