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1.
Laryngoscope ; 126 Suppl 3: S5-12, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26490680

RESUMO

OBJECTIVES/HYPOTHESIS: Approach-specific economic data of acoustic neuroma (AN) resection is lacking. The purpose of this study was to analyze and compare adjusted total hospital costs, hospital and intensive care unit (ICU) length of stay (LOS), and associated factors in AN patients undergoing resection by translabyrinthine (TL) approach versus retrosigmoid (RS) approach. STUDY DESIGN: Retrospective chart review. METHODS: A total of 113 patients with AN undergoing TL (N = 43) or RS (N = 70) surgical resection between 1999 and 2012 were analyzed. Data including age, health status, preoperative hearing, tumor size, postoperative complications, hospital, ICU LOS, and disposition after discharge were collected from medical records and compared between both groups. Cost data was obtained from the hospital finance department and adjusted based on the Consumer Price Index for 2013. RESULTS: There were no significant differences in demographic data, preoperative hearing, preoperative health status, or postoperative complication rate. Total hospital LOS and ICU LOS were significantly longer in the RS compared to the TL group (4.3 ± 3.6 vs. 2.6 ± 1.1 days; P < 0.001, and 1.5 ± 1.1 vs. 1.0 ± 0.5 days; P = 0.015, respectively). Tumors were larger in RS compared to the TL group (2.1 ± 1.0 cm vs. 1.5 ± 0.7 cm, respectively; P = 0.002). When patients were stratified by tumor size < or ≥ 2 cm, the total hospital LOS remained greater in the RS group in both subgroups (< and ≥ 2 cm, P < 0.001, and P = 0.031, respectively). However, there was no difference in the total ICU LOS between both subgroups. The adjusted mean total hospital cost was higher in the RS compared to the TL group ($25,069 ± 14,968 vs. $16,799 ± 5,724; P < 0.001). The adjusted mean total hospital cost was greater in the RS group with tumor < 2 cm (P < 0.001) but not significantly different in patients with tumors ≥ 2 cm. Univariate analysis showed that greater tumor size, poorer preoperative health status, the presence of major postoperative complications, and the RS approach were independently significantly associated with higher total hospital LOS (P = 0.001, P = 0.009, P = 0.001, and P < 0.001, respectively) and a higher adjusted total hospital cost (P < 0.001, P = 0.002, P = 0.014, and P < 0.001, respectively). CONCLUSION: Hospital LOS and total adjusted costs are significantly less for patients undergoing translabyrinthine acoustic neuroma resection compared to the retrosigmoid approach. Many factors appear to influence these differences. Economic considerations in addition to tumor characteristics and surgeon preference should be considered in future acoustic neuroma resections. LEVEL OF EVIDENCE: 2c.


Assuntos
Orelha Interna/cirurgia , Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otológicos/economia , Canais Semicirculares/cirurgia , Adulto , Análise Custo-Benefício , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , Carga Tumoral
2.
Arch Otolaryngol Head Neck Surg ; 136(7): 648-57, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20644058

RESUMO

OBJECTIVES: (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation. DESIGN: Retrospective cohort study. SETTING: University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio. PARTICIPANTS: Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008. MAIN OUTCOME MEASURES: Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation. RESULTS: A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients. CONCLUSIONS: In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.


Assuntos
Implante Coclear/economia , Acessibilidade aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde , Cobertura do Seguro/economia , Medicaid/economia , Adolescente , Análise de Variância , Criança , Pré-Escolar , Implante Coclear/tendências , Implantes Cocleares/economia , Implantes Cocleares/estatística & dados numéricos , Estudos de Coortes , Feminino , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/cirurgia , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Setor Privado/economia , Probabilidade , Estudos Retrospectivos , Medição de Risco , Fatores Socioeconômicos , Resultado do Tratamento , Estados Unidos
3.
Curr Opin Otolaryngol Head Neck Surg ; 16(5): 420-6, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18797283

RESUMO

PURPOSE OF REVIEW: To provide an overview on the recent advances in the diagnosis and treatment of glomus tumors (paragangliomas). RECENT FINDINGS: The review focuses on the genetics of paragangliomas and discusses the role of newer therapeutic modalities in the management of jugulotympanic paragangliomas. SUMMARY: Recent advances in the field of genetics allowed the identification of three main loci involved in hereditary paragangliomas. Genetic screening of patients with family history identifies affected individuals. The management of glomus tumors continues to be a challenging task. Surgery remains the mainstay of treatment for young healthy patients with functional cranial nerve deficits. Gamma knife radiosurgery is offered as an adjunctive to limited surgery and as the primary treatment modality in poor surgical candidates or patients with bilateral disease.


Assuntos
Diagnóstico por Imagem/métodos , Tumor Glômico/diagnóstico , Tumor Glômico/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Angiografia/métodos , Feminino , Tumor do Glomo Jugular/diagnóstico , Tumor do Glomo Jugular/epidemiologia , Tumor do Glomo Jugular/cirurgia , Tumor Glômico/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Incidência , Imageamento por Ressonância Magnética/métodos , Masculino , Estadiamento de Neoplasias , Paraganglioma/diagnóstico , Paraganglioma/epidemiologia , Paraganglioma/cirurgia , Prognóstico , Intensificação de Imagem Radiográfica , Radiocirurgia/métodos , Medição de Risco , Taxa de Sobrevida , Tomografia Computadorizada por Raios X/métodos
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