Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective

Chandran, Dhinashini; Woods, Charmaine M.; Schar, Mistyka; Ma, Nalda; Ooi, Eng H.; Athanasiadis, Theodore

doi:10.1017/s0022215117001384

Cited by 8 publications

(17 citation statements)

References 18 publications

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“…Though hospitalization was shorter in the conscious sedation group, the total costs were not significantly different. Further, studies describing the costs of different surgical interventions under local versus general anaesthesia found a significant reduction in cost when performing the intervention under local anaesthesia [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Snijder

Renes

Swaans

et al. 2020

Journal of Interventional Cardiology

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Objective. To study the safety and efficacy of microtransesophageal echocardiography (micro-TEE) and TEE during percutaneous atrial septal defect (ASD) and patent foramen ovale (PFO) closure. Background. TEE has proven to be safe during ASD and PFO closure under general anaesthesia. Micro-TEE makes it possible to perform these procedures under local anaesthesia. We are the first to describe the safety and efficacy of micro-TEE for percutaneous closure. Methods. All consecutive patients who underwent ASD and PFO closure between 2013 and 2018 were included. The periprocedural complications were registered. Residual shunts were diagnosed using transthoracic contrast echocardiography (TTCE). All data were compared between the use of TEE or micro-TEE within the ASD and PFO groups separately. Results. In total, 82 patients underwent ASD closure, 46 patients (49.1 ± 15.0 years) with TEE and 36 patients (47.8 ± 12.1 years) using micro-TEE guidance. Median device diameter was, respectively, 26 mm (range 10–40 mm) and 27 mm (range 10–35 mm). PFO closure was performed in 120 patients, 55 patients (48.6 ± 9.2 years, median device diameter 25 mm, range 23–35 mm) with TEE and 65 patients (mean age 51.0 ± 11.8 years, median device diameter 27 mm, range 23–35 mm) using micro-TEE. There were no major periprocedural complications, especially no device embolizations within all groups. Six months after closure, there was no significant difference in left-to-right shunt after ASD closure and no significant difference in right-to-left shunt after PFO closure using TEE or micro-TEE. Conclusion. Micro-TEE guidance without general anaesthesia during percutaneous ASD and PFO closure is as safe as TEE, without a significant difference in the residual shunt rate after closure.

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Section: Discussionmentioning

confidence: 99%

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Snijder

Renes

Swaans

et al. 2020

Journal of Interventional Cardiology

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“…All articles used financial data based on actual cases, except for the studies of Castillo Farías et al [25] and Schutte et al [21], who estimated costs based on costs of materials, facilities and personnel required to perform these procedures in general. Hospital costs were discussed in seven studies [9, 10, 21, 22, 25-27]; hospital charges in eight studies [9, 11, 20, 23, 24, 27-29]. All included studies reported on costs from a hospital’s perspective.…”

Section: Resultsmentioning

confidence: 99%

“…The time frame in which financial data were collected ranged from 1995 to 2018. In the studies of Hillel et al [27] and Chandran et al [26], the analyzed costs were about awake surgery performed in the (in-hospital) endoscopy suite or instead of the office. The included parameters for costs or charges differed among studies.…”

Section: Resultsmentioning

confidence: 99%

“…The relative reduction in total hospital costs including physician fees ranged from 27% [27] to 95% [25] per procedure. Specifically, for VFI procedures, total costs ranged from €980 [26] to €2.347 [27] when performed in an OB setting, and from €1.622 [26] to €3.191 [27] when performed in the OR. Costs of OB TNFLS ranged from €2.185 [9] to €2.234 [27], and for OR-performed TNFLS costs ranged from €4.186 [27] to €4.383 [9].…”

Section: Resultsmentioning

confidence: 99%

“…Costs for learning these new surgical techniques (e.g., costs for courses and prolonged surgery duration) were not considered in any of the studies. Third, two of the included studies described that awake surgery was performed in the endoscopy suite [27] or in the OR [26], instead of the (non-facility based) office, to bypass reimbursement problems for in-office procedures. Both reports described the least cost reductions among the included articles.…”

Section: Discussionmentioning

confidence: 99%

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Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Schimberg

Wellenstein

Broek

et al. 2019

Eur Arch Otorhinolaryngol

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PurposeOffice-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings.MethodsPubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed.ResultsOf 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial.ConclusionOffice-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.Electronic supplementary materialThe online version of this article (10.1007/s00405-019-05617-z) contains supplementary material, which is available to authorized users.

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Improving Operating Room Efficiency in Otolaryngology–Head and Neck Surgery: A Scoping Review

Hathi,

Nam,

Fowler

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveOne minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology.Data SourcesMEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022.Review MethodsPublished English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta‐analysis reporting for scoping reviews was followed.ResultsThe search yielded 9316 no‐duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on‐call cases.ConclusionThe current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers.

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Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective

Cited by 8 publications

References 18 publications

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Improving Operating Room Efficiency in Otolaryngology–Head and Neck Surgery: A Scoping Review

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