Perioperative cost evaluation of canal wall down mastoidectomy.

INTRODUCTION: To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU) mastoidectomy. METHODS: This study is a retrospective chart review of adult patients who underwent CWD mastoidectomy for chronic otitis media with or without cholesteatoma at a tertiary referral center. Patients were divided into groups that had previous CWU surgery and were undergoing revision CWD and those that were having an initial CWD mastoidectomy. Cost variables including previous surgeries, imaging costs, audiometric testing, and post-operative visits were compared between the two groups using t-test analysis. RESULTS: There was no significant difference with regards to the cost of post-operative visits, peri-operative imaging, or revision surgeries between the two groups. Hearing outcomes based on mean speech reception threshold (SRT) were not statistically different between the two groups (p = 0.087). There was a significant difference in total cost with the revision group having a higher mean cost by $6967.84, most of which was accounted for by the difference in the cost of the previous surgeries of $6488.53. CONCLUSIONS: The revision CWD surgery group had increased total cost that could be attributed to the cost of previous surgery. Increased peri-operative cost was not noted with the initial CWD surgery group for any individual variables examined. Initial CWD mastoidectomy should be considered in the proper patient population to help decrease healthcare costs.

Utility and cost analysis of cholesteatoma histopathologic evaluation.

OBJECTIVES/HYPOTHESIS: To evaluate the correlation between the surgeon's intraoperative findings and histopathologic diagnosis of cholesteatoma specimens and the associated health care cost in requesting pathologic evaluation. STUDY DESIGN: Retrospective chart analysis. METHODS: Chart data were collected at a tertiary neurotology referral center from patients undergoing tympanomastoidectomy for chronic otitis media, with specimens submitted for pathologic review between 2010 and 2011. Correlation between the surgeon's intraoperative findings and the pathologic diagnosis was evaluated using a kappa statistic. Cost analysis for pathologic consultation was also reviewed. RESULTS: A Cohen's kappa value of 0.93 (P < .01) was found between the surgeon's intraoperative findings and pathologic diagnosis. Using accepted kappa magnitude guidelines, there is perfect agreement between the surgeon's intraoperative findings and pathologic diagnosis of cholesteatoma after tympanomastoidectomy. The average cost for microscopic evaluation of cholesteatoma (current procedural terminology code 88304) as estimated per 2012 Medicare reimbursement rates is $61.95. CONCLUSIONS: In the absence of concern for other pathology, intraoperative findings of cholesteatoma are adequate to confirm diagnosis in patients undergoing tympanomastoidectomy for chronic otitis media without the use of histopathology. The increased cost of routine cholesteatoma histopathologic evaluation should be considered in future health care cost-containing measures, as clinical utility appears to be low. LEVEL OF EVIDENCE: 4.