Economic impact of a head and neck oncologic surgeon: The case mix index

Jalisi, Scharukh; Sanan, Akshay; McDonough, Katie A.; Hussein, Khalil I.; Platt, Michael; Truong, Minh Tam; Couch, Marion; Burkey, Brian B.

doi:10.1002/hed.23470

Cited by 4 publications

(5 citation statements)

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“…It is well known that inpatient otolaryngology cases have a high CMI, primarily due to the complexity of head and neck oncology patients and high complexity values assigned to tracheostomy patients. 5 Intuitively, otolaryngology patients with a high CMI also have high rates of 30-day readmission rates and high rates of postoperative complications, all of which increase total costs. [19][20][21][22][23][24] Patients with high CMI may also have increased costs inherent to their disease process, regardless of interventions performed.…”

Section: Discussionmentioning

confidence: 99%

“…CMI has been shown to explain variations in cost between hospitals, with high CMI correlating with increasing cost. 5-7 Similarly, patient volume has been established to negatively affect mortality outcomes in general surgical patients. 8…”

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confidence: 99%

“…CMI has been shown to explain variations in cost between hospitals, with high CMI correlating with increasing cost. [5][6][7] Similarly, patient volume has been established to negatively affect mortality outcomes in general surgical patients. 8 Despite work in other fields, in otolaryngology-head and neck surgery, there has been comparatively little analysis around the impact of case volume and complexity on value.…”

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confidence: 99%

“…It is calculated for each hospital based on the amount of resources that are used to care for each patient with a discrete diagnosis. CMI has been shown to explain variations in cost between hospitals, with high CMI correlating with increasing cost 5–7 . Similarly, patient volume has been established to negatively affect mortality outcomes in general surgical patients 8 …”

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confidence: 99%

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Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Redmann

Yuen

VonAllmen

et al. 2019

Otolaryngol.--head neck surg.

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Objectives (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Study Design Retrospective case series. Setting Tertiary academic hospital. Subjects and Methods The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. Results In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. Conclusion For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Redmann

Yuen

VonAllmen

et al. 2019

Otolaryngol.--head neck surg.

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“…24 Multidisciplinary expertise in high-volume centers can affect outcome, given that TL, PL, and CRT can be operator-dependent and influenced by surgeon and radiation oncologist experience. 25,26 We found that 11.6% of patients were treated at a community facility, 44.8% were treated at a comprehensive community facility, and 43.6% were treated at an academic facility. Surgical expertise and high-quality RT design and delivery (including target-volume delineation and the use of an intensity-modulated RT technique) affect outcomes, and we attempted to mitigate their confounding effects in this analysis by adjusting for treatment facility type in our multivariate analyses.…”

Section: Discussionmentioning

confidence: 88%

Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer

Patel

Qureshi

Dyer

et al. 2019

Cancer

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BACKGROUND:The declining 5-year overall survival (OS) of patients with laryngeal cancer has been associated with increased nonsurgical management of stage III/IV disease. To further assess this hypothesis, the authors evaluated recent OS trends and patterns of use between larynx-preserving approaches with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy (TL) stratified by tumor and nodal burden. METHODS: The National Cancer Data Base was used to identify 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated between 2003 and 2011 with CRT or upfront PL or TL with or without adjuvant therapy. OS was analyzed using the Kaplan-Meier method and a Cox proportional hazards model. RESULTS: Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL. Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT (hazard ratio, 1.25; 95% CI, 1.04-1.51; P = .016). For T4N0-N3 tumors, TL compared with CRT was associated with improved OS (hazard ratio, 0.80; 95% CI, 0.62-0.92; P = .002). No statistically significant difference in outcome was noted between CRT and PL for all stage groups. The use of CRT has declined and receipt of TL has increased since 2006 for T4 disease, whereas PL rates have remained stably low. CONCLUSIONS: No survival differences were noted between surgical and nonsurgical approaches for patients with non-T4, low nodal burden laryngeal cancer. Patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease. Cancer 2019;125:3367-3377.

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The Ongoing Gap in Availability of Imaging Services at Teaching Versus Nonteaching Hospitals

2016

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Economic impact of a head and neck oncologic surgeon: The case mix index

Cited by 4 publications

References 4 publications

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer

The Ongoing Gap in Availability of Imaging Services at Teaching Versus Nonteaching Hospitals

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