Reducing Hospital Costs for Patients Undergoing TL/BND

What factors influence intraoperative and postoperative costs associated with total laryngectomy (TL) and bilateral neck dissection (BND)?

Background: Given the current environment of health care reform, the ability to respond to the financial challenges ahead requires an understanding of the drivers of cost variation for surgical procedures. Only by examining both the costs associated with specific hospital services in the intraoperative and postoperative period and the impact of patient factors on hospital costs can clinical pathways be adjusted to reduce the cost of health care delivery.

This is the first study to undertake cost-identification analysis for a specific head and neck procedure, total laryngectomy with primary closure and bilateral neck dissection.

Study Design: This is a retrospective chart review of cost data for 112 patients identified in the Pittsburgh Head and Neck Organ-Specific Database undergoing TL/BND from 1999-2009.

Setting: Tertiary care teaching hospital system.

Synopsis: Total hospital costs for TL/BND ranged from $10,915 to $120,345 (mean=$29,563). The perioperative period, including operating room costs the day of surgery, accounted for 38 percent of total hospital costs. The operating room alone accounted for 24 percent of total costs, while room charges, respiratory therapy, laboratory, pharmacy and radiology accounted for 38 percent, 14 percent, 8 percent, 7 percent and 3 percent, respectively.

There was a weak correlation with increase in co-morbidity index and a strong correlation with length of stay (median length of stay was nine days, with a range of six to 43 days), and the total hospital cost for patients requiring one or more days in the ICU nearly doubled ($46,831 vs $24,601, P < 0.01). There was no correlation with age, gender, surgeon, radiation therapy or readmission within 30 days.

Bottom line: Based on cost-identification analysis, in this study, the primary drivers for cost variation in patients undergoing TL/BND include length of stay and days in ICU. While co-morbidity index may influence these two parameters, the ability to manage patients outside of the ICU setting represents an opportunity to reduce total hospital costs.

Citation: Dedhia RC, Smith KJ, Weissfeld JL, et al. Cost-identification analysis of total laryngectomy: an itemized approach to hospital cost. Otolaryngol Head Neck Surg. 2011;144(2):220-224.

—Reviewed by Paul W. Flint, MD