Cost Analysis of Channeled, Distal Chip Laryngoscope for In-office Laryngopharyngeal Biopsies.

OBJECTIVE: Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy. STUDY DESIGN: Retrospective, financial analyses were performed. METHODS: Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded. RESULTS: Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment. CONCLUSION: In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.

The hidden cost of deep neck space infections

Introduction The incidence of deep neck space infection (DNSI) is rising and appears to be related to falling rates of tonsillectomy. The purpose of this study was to assess demographics of patients presenting with DNSI and the financial burden to the National Health Service (NHS). Methods Data were collected retrospectively on patients aged over 16 years admitted to NHS Greater Glasgow and Clyde with DNSI between 2012 and 2016. Demographics, aetiology and use of hospital resources were reviewed. The cost of hospital admissions was calculated using data from NHS Scotland's Information Services Division, the local diagnostics division and the British National Formulary. Results Seventy-four patients were admitted with DNSI during the study period. Forty (54%) were male. The mean age was 44.0 years (range: 16-86 years). The most frequent source of infection was the tonsil (n=30, 40.5%). The most common infective organism was Streptococcus constellatus (n=9, 12.2%). The mean length of stay was 11 days. Fifty-five patients (74.3%) required operative intervention. The mean cost of admission per patient was £5,700 (range: £332-£46,700). Conclusions This study highlights the high cost burden of DNSI to the NHS. The incidence of DNSI in Glasgow has risen over the study period; contributing factors may include the reduced tonsillectomy rate and a reduction in antibiotic prescribing. As the incidence of DNSI continues to rise, there will be an increase in cost to the NHS, which must be planned for.

The Public Health Impact of Pediatric Deep Neck Space Infections.

OBJECTIVE: There is little consensus about the best management of pediatric deep neck space infections (DNSIs) and limited information about the national disease burden. The purpose of this study is to examine the health care burden, management, and complications of DNSIs from a national perspective. STUDY DESIGN: Retrospective administrative data set review. SETTING: National pediatric admission database. SUBJECTS AND METHODS: Pediatric patients diagnosed with a parapharyngeal space and/or retropharyngeal abscess were identified from the 2009 KIDS' Inpatient Database. Patient demographic, hospital, and clinical characteristics were compared between patients who received surgical and nonsurgical management. All results for the analyses were weighted, clustered, and stratified appropriately according to the sampling design of the KIDS' Inpatient Database. RESULTS: The prevalence of DNSIs was 3444 in 2009, and the estimated incidence was 4.6 per 100,000 children. The total hospital charges were >$75 million. The patients who were drained surgically had a 22% longer length of stay (mean = 4.19 days) than that of those who were managed without surgery (mean = 3.44 days). Mean hospital charges for patients who were drained surgically were almost twice those of patients who were managed medically ($28,969 vs $17,022); 165 patients (4.8%) had a complication. RESULTS: There are >3400 admissions for pediatric DNSIs annually, and they account for a significant number of inpatient days and hospital charges. A randomized controlled trial of management may be indicated from a public health perspective.

Intraoral drainage: recommended as the initial approach for the treatment of parapharyngeal abscesses.

OBJECTIVE: We sought to compare the efficacy, safety, and cost of intraoral drainage (IOD) of parapharyngeal abscesses (PPAs) in the pediatric population with those of the more commonly used external neck drainage (END). PATIENTS AND STUDY DESIGN AND SETTING: An 11-year retrospective review was conducted of all patients admitted to a tertiary-care, university-affiliated, pediatric hospital with a diagnosis of PPA. Patients were divided into 2 groups according to the treatment received (IOD or END) and were followed to 1 month postoperatively. All children referred to our institution with a final diagnosis of PPA were included in the study. OUTCOME: Outcome measures were duration of anesthesia, duration of postoperative intravenous antibiotics (DPOIA), length of postoperative hospital stay (LPOHS), and occurrence of complications. RESULTS: Fifteen patients underwent IOD, and 10 patients, END. IOD shortened anesthesia time by 31.7 minutes compared with END (P = 0.0003). IOD was associated with a decrease in DPOIA and LPOHS by 1.1 days (P = 0.1931) and 1.6 days (P = 0.0649), respectively. The cost of treatment was thereby reduced. No complications were encountered in either group. CONCLUSIONS: IOD is a safe and effective treatment for PPA in the pediatric population. It leads to decreased morbidity, shortened anesthesia time, and reduced economic burden.

Cost-effective management of pharyngocutaneous fistulas following laryngectomy.

A pharyngocutaneous fistula following a total laryngectomy is not an uncommon occurrence. The incidence of this serious complication ranges worldwide from 7.6 percent to 50 percent. It usually exacerbates post-operative morbidity and increases expense with prolonged hospitalization. This complication often requires additional operative procedures or if untreated may lead to a fatal complication such as carotid artery rupture. There are multiple predisposing factors leading to poor wound healing in this patient population. These factors include prior radiation therapy, chemotherapy, compromised nutrition, and associated surgical procedures including radical neck dissection. A treatment strategy for difficult fistulas with undermining is presented here. The cornerstones of this approach include opening the area large enough for packing and cleansing, diverting the copious pharyngeal secretions and providing an optimal wound environment through the use of an amorphous hydrogel dressing (Intrasite* Gel, Smith & Nephew United, Inc., Largo, FL). This treatment strategy led to complete and sustained healing when utilized by the authors in the following patients. It was successful even in heavily irradiated tissue with its severe changes of compromised vascularity, increased dermal fibrosis and epidermal thinning. The authors have found this technique a cost-effective alternative to secondary surgery, applicable in both the acute and home care settings.

Effect of tonsillectomy on health-related quality of life and costs.

CONCLUSION: Tonsillectomy (TE) seems to be a cost-saving procedure with a positive effect on a patient's health-related quality of life (HRQoL). OBJECTIVES: The aim of this study was to explore how TE affects health-related quality of life (HRQoL) and the costs due to health service use and absence from work. METHODS: All 557 patients over the age of 15 years undergoing scheduled TE in the Helsinki University Central Hospital's Otorhinolaryngological Department between February 2008 and June 2009 were asked to participate and to complete the 15D HRQoL questionnaire as well as a questionnaire exploring the use of health-care services during the preceding 3 months. Follow-up questionnaires were sent 6 and 12 months after the operation. RESULTS: Of the 557 patients, 124 (22%) answered all three questionnaires. Preoperatively the patients were significantly worse off than the age- and gender-standardized general population. TE improved their HRQoL on 6 of the 15 dimensions, and overall (15D score improved from baseline 0.939 to 0.959 at 12 months, p < 0.001). The most marked improvement (p < 0.001) occurred on the dimensions of breathing, sleeping, and discomfort and symptoms. Self-reported costs due to health service use and absence from work distinctly diminished.

Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience.

OBJECTIVES: The purpose of this study was to compare the efficacy of a pectoralis major myogenous flap in the prevention of pharyngocutaneous fistula in patients who have undergone total laryngectomy. Our secondary objective was to estimate the economic saving to our health care system. DESIGN: Retrospective clinical study. SETTING: Grace General Hospital, St. Clare's Mercy Hospital, H. Bliss Murphy Cancer and Research Centre, St. John's, Newfoundland. MATERIALS AND METHODS: Two hundred and twenty-three consecutive total laryngectomy procedures performed between June 1978 and December 2001 were reviewed. The fistula rate in laryngectomy patients prior to 1988 without pectoralis major myogenous flaps (group A) was compared with that of patients after June 1988 who had this flap routinely used at primary surgery (group B). Analysis of risk factors within those two groups was essentially similar. RESULTS: In group A, the overall pharyngocutaneous fistula rate was 22.9%. The fistula rate in group B was less than 1%. CONCLUSION: Our study has demonstrated that at our tertiary care head and neck oncology centre, we have dramatically decreased the incidence of postlaryngectomy pharyngocutaneous fistula. By the routine addition of a pectoralis major myogenous flap to cover the pharyngeal defect at surgery, we have substantially and dramatically reduced patient morbidity and mortality and reduced hospital stay, with major financial savings to the health care system.