Adding Office-Based Laryngeal Procedures to Your Practice Can Benefit Patients

Adding office-based or awake laryngeal procedures to your practice is possible, and, once incorporated, it could be a big benefit, panelists said in a session at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation, held in Dallas.

“It’s potentially good for the patients,” said Richard McHugh, MD, PhD, co-director of the University of Alabama Birmingham Voice and Aerodigestive Center. “The patients might like it better and, potentially, it’s good for us.”

Adam Klein, MD, associate professor at the Emory Voice Center in Atlanta, said physicians could consider performing certain procedures in the endoscopy suite, rather than in the operating room (OR). Doing this frees up OR time, and it’s also an opportunity for physicians to develop new skills, as well as improve patient quality of life. “As you do more awake procedures, you find more applications for it,” Dr. Klein said. The suites generally already have, or can be fairly easily equipped with, what is needed for awake laryngeal procedures, he said, and the rooms are a little larger.

Dr. Klein said his team made the switch at Emory 10 years ago. The endoscopy suites were available to a surprising degree, so the physicians proposed using them for five cases a month. The hospital agreed that this plan would be worth its while. The equipment costs are covered by the hospital, and so is the expense of expired injectables.

Dr. Klein and his colleagues put together a study on the cost and found that it does save money compared with performing the same procedures in the OR. At the same time, due to decreased overhead, the hospital usually nets more. For an injection laryngoplasty, for example, the net gain when performing it in the OR was just $37, but was $315 in the endoscopy suite. “It is less expensive for the system as a whole, and more cost efficient for the hospital,” Dr. Klein said.

Potential Hurdles

Adam Rubin, MD, co-director of Lakeshore Professional Voice Center in Michigan, said that he has incorporated awake laryngeal procedures—while pointing out that he wasn’t necessarily referring to office procedures—into his private practice. Any injections that don’t require an additional scope driver can be done fairly easily, he said, while awake laser procedures and those needing another scope driver are more difficult.

There are some hurdles when it comes to cost, personnel, and critical volume, he said. Just about everything, especially the laser, is expensive, but one cost saving possibility is asking the hospital or the surgical center to buy the laser. That might make sense, because it can be used for general-anesthesia cases and by other specialties, too, he said.