Frequency, variation and cost of dental extractions for adults in secondary care in Great Britain

We have conducted a survey of administrative data aiming to investigate the reported provision of dental extraction under general anaesthesia in the National Health Services for adults in secondary care in the following aspects: 1. anaesthetic data accessibility by the NHS organisations; 2. the number and proportion of dental extraction episodes by anaesthetic modality and procedure type; 3. the economic cost of dental general anaesthesia for adults; 4. variations in the anaesthetic provision between a. commissioning regions b. organisation types. We collected data from individual secondary care National Heatlh Services organisations that provide dental extraction services in England, Wales and Scotland. We devised a data collection form to capture the number of episodes of dental extraction under each relevant oral surgery procedure code per anaesthetic modality per institution from October 2015 to September 2016. The majority (64.0%, n=96,659) of the episodes were categorised into an anaesthetic modality; 39.2% (n=37,902) under general anaesthesia, 18.7% (n=18,050) under sedation, and 42.1% (n=40,707) under local anaesthesia. The majority of sedation provision (84.9%) derived from dental hospitals. A substantial proportion (37.0%) of the episodes could not be assigned an anaesthetic modality. Variations in dental general anaesthesia activity were observed with respect to the commissioning regions and organisation types. The annual cost of adult dental general anaesthesia from 81 out of 150 organisations that provided dental general anaesthesia data was estimated to be over £19 million based on the National Health Services Payment by Results Tariff 2015-2016. Our data suggest that the number of adult dental general anaesthesia episodes and the associated cost are considerable, and highlight the scope for improving the quality of data for commissioners and providers to support discussions over patient pathways.