In-Office vs. Operating Room Procedures for Recurrent Respiratory Papillomatosis

Abstract

We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients—1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures—5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

Recurrent Respiratory Papillomatosis Office versus Operating Room: Systematic Review and Meta-Analysis

“…The weighted mean time interval between OR-based procedures was 10.59 months (95% CI 5.83-15.35, n = 2, I 2 = 49%, τ 2 = 6.9391, P = .16). Only Miller et al 17 reported the time interval between office procedures, which was 5.40 months with 95% CI (3.26, 7.54). Reasons for reintervention included bulky disease requiring subsequent OR surgery, 21 recurrence, 33 or repeat operation for otherwise unspecified reason, 30 but there was no mention of staged procedures affecting the inter-operative interval.…”

“…Of the 18 studies, only one 17 directly compared operative in-office treatment to OR treatment of RRP, analyzing the number of procedures, time interval between procedures, complications, and cost between the two treatment settings. Another study 18 compared cost between office and OR.…”

“…However, for five of these (two office-based 21,23 and three OR-based 29,30,33 ), no standard deviation was available or able to be calculated, so the number of procedures from only 8 studies was used (Figure 2). Six 24,25,27,28,31,34 of the 8 studies were OR-based, one 22 was office-based, and one 17 was both office- and OR-based. The weighted mean number of OR procedures was 1.47 (95% CI 1.22-1.72, n = 7, I 2 = 63%, τ 2 = 0.0557, and P = .01).…”

“…Five studies reported the time interval between treatments for RRP, but the standard deviation was unavailable for 3 of these studies (one 21 office-based and OR-based and two 30,33 OR-based). Of the remaining two studies, one 34 was OR-based only, while the other 17 compared office to OR outcomes and therefore provided the time interval between procedures done in both treatment settings (Figure 3). The weighted mean time interval between OR-based procedures was 10.59 months (95% CI 5.83-15.35, n = 2, I 2 = 49%, τ 2 = 6.9391, P = .16).…”

“…Thirteen different studies reported complications and complication rates of RRP treatment (Table 2, Figure 4). Seven 24,27,29-31,33,34 were OR-based treatment, while five 19-23 were office-based treatment, and one study 17 assessed both OR and office. The weighted complication rate for OR-based treatment of RRP was 0.02 (95% CI 0.00-0.32, n = 8, I 2 = 94%, τ 2 = 8.9901, P = .09).…”