Cost‐Identification Analysis of Total Laryngectomy

Abstract

Objectives To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Study Design Case series with chart review. Setting Large tertiary care teaching hospital system. Subjects and Methods Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Results Mean total hospital costs were $29 563 (range, $10 915 to $120 345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6–43), and median Charlson comorbidity index score was 8 (2–16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46 831 vs $24 601, P < .01). The authors found no significant cost differences with stratification based on previous radiation therapy ($27 598 vs $29 915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29 483 vs $29 609 without readmission, P = .97). Conclusion This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.

Bradykinin Receptor B1 and C-Reactive Protein as Prognostic Factors for Pharyngocutaneous Fistula Development After Laryngectomy

“…Permanent salivary leakage from the communication leads to ongoing inflammation that inhibits proper wound healing and the onset of complementary therapy. This prolongs hospitalization, increases the costs of treatment, and, most importantly, strains the patient's physical and psychological well-being [3][4][5].…”

Analysis of Charges Associated with Definitive Nonsurgical Therapy for Early-Stage Lateralized Tonsil Cancer

“…Of interest, on multivariate analysis, treatment-related hospitalizations and emergency room visits did not significantly correlate with increased charges (p=0.145 and p=0.290, respectively). Others have identified intensive care unit stays as having the greatest impact on cost 10 and none of our patients required an intensive care unit stay.…”

“…8 While having the advantage of determining actual cost, relying on claims coding to identify patients and treatments is not without fault; 24.5% to 67.1% of patients identified by a diagnosis of cancer had no consequent identifiable treatment. 4,9,10 …”

“…Dedhia et al undertook cost identification of charges surrounding a particular procedure: total laryngectomy. 10 By extrapolating costs based on known departmental cost/charge ratios, they demonstrated that operating room costs comprised 24% of the total cost, whereas room charges accounted for 38% of the total cost. 10 As in the current study, Funk et al approached charges from a disease perspective; they tallied charges from pre-treatment evaluation to one-year post-treatment follow-up for oral cavity cancer, finding that T stage, N stage, TNM stage, uni- versus multi-modality treatment, and patient comorbidities significantly impacted the cost of care.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…As possible explanation, the authors mention an increasing number of salvage surgeries and higher complications rates in the context of overall less performed interventions. In a retrospective study, Dedhia et al [166] demonstrated that the surgery costs accounted for an average of 24% of the whole hospital expenses while rooms, respiration therapy, laboratory, pharmacy, and radiology made up 38%, 14%, 8%, 7%, and 3%, respectively. In a model of decision analysis with data from studies, case series, and meta-analyses, Davis et al [167] came to the conclusion that total laryngectomy with postoperative radiotherapy costs nearly $ 3,000 less than induction chemotherapy followed by radiotherapy.…”