Office‐based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis

Howell, Rebecca J.; Schopper, Melissa A.; Giliberto, John Paul; Collar, Ryan M.; Khosla, Sid

doi:10.1002/lary.27121

Cited by 12 publications

(23 citation statements)

References 21 publications

(45 reference statements)

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“…From this selection, another 49 articles were excluded because inclusion criteria were not met. The search update yielded three additional articles suitable for inclusion [20-22]. In total, 13 articles were included [9-11, 20-29].…”

Section: Resultsmentioning

confidence: 99%

“…All articles used financial data based on actual cases, except for the studies of Castillo Farías et al [25] and Schutte et al [21], who estimated costs based on costs of materials, facilities and personnel required to perform these procedures in general. Hospital costs were discussed in seven studies [9, 10, 21, 22, 25-27]; hospital charges in eight studies [9, 11, 20, 23, 24, 27-29]. All included studies reported on costs from a hospital’s perspective.…”

Section: Resultsmentioning

confidence: 99%

“…The included parameters for costs or charges differed among studies. For example, some studies explicitly described that purchase costs, write-off and maintenance of technical equipment, such as for video-endoscopes with working channel, were incorporated in the cost-analysis [9, 20-22, 26]. Two studies did not specify the items included in the costs analysis [23, 24].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies did not specify the items included in the costs analysis [23, 24]. One study did not include physician fees in the cost-analysis, but focused rather on facility costs [20]. Table 3 demonstrates the number of studies that addressed the costs of the different procedures.…”

Section: Resultsmentioning

confidence: 99%

“…2 and 3, the large differences in costs and charges can be deducted. Additionally, a substantial variation existed within hospital charges, especially in OR-performed procedures (€3.677 [11]–€15.080 [20]).

Fig. 3Hospital charges (with and without physician fees) for office-based and OR-performed procedures in Euros per procedure…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Schimberg

Wellenstein

Broek

et al. 2019

Eur Arch Otorhinolaryngol

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PurposeOffice-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings.MethodsPubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed.ResultsOf 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial.ConclusionOffice-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.Electronic supplementary materialThe online version of this article (10.1007/s00405-019-05617-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fig. 3Hospital charges (with and without physician fees) for office-based and OR-performed procedures in Euros per procedure…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Schimberg

Wellenstein

Broek

et al. 2019

Eur Arch Otorhinolaryngol

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National Database Outcomes of Esophageal Dilations

et al. 2020

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Objectives/Hypothesis: To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes.Study Design: Observational, retrospective cohort study. Methods: We queried a national database of insurance claims for Current Procedural Terminology (CPT) codes representing esophageal dilation performed between 2011 and 2017. Patients aged 18 to 100 who were continuously enrolled with their insurance provider were included. Demographic information, additional CPT codes, concomitant diagnoses, and anticoagulant medication data were collected for all patients included. Postoperative mortality was assessed and International Classification of Diseases (ICD)9/10 codes for complications, including esophageal perforation, hemorrhage, mediastinitis, and sepsis were flagged.Results: We identified 202,965 encounters for esophageal dilation. Of these procedures, 193 were performed on a patient who underwent percutaneous endoscopic gastrostomy (PEG) during the study period and was analyzed separately. Another 244 dilations were excluded due to repeat entries. Of the remaining 202,528 procedures remaining, 42,310 were repeat dilations in the same patient. Data analysis was confined to each patient's initial dilation. 160,218 initial dilations remained. Of these, 62,107 were performed on male patients and 98,111 were performed on female patients. The average age was 57.7 years. There were 12 mortalities within 30 days postoperatively, representing 0.0075% of all dilations. Esophageal perforation and esophageal hemorrhage were the most common reported complications, with 139 and 110 occurrences, respectively. The overall per-dilation complication rate was 0.215%.Conclusions: Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a low rate of serious complications and a 30-day all-cause mortality rate of less than 1 per 10,000 dilations.

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Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

et al. 2023

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ObjectivesTo evaluate the long‐term benefit of serial in‐office steroid injections (SISI) in the treatment of subglottic and proximal tracheal stenosis (SG/PTS). Evaluate cost of SISI compared to endoscopic dilation (ED).Study DesignRetrospective study and cost analysis.MethodsAll patients with SGS/PTS with at least two consecutive in‐office steroid injections between 2013 and 2021 were evaluated. Patients with less than 2 years of follow‐up data after the initial SISI series were excluded. Demographics, etiology of stenosis, total injections performed, time between steroid series, surgery‐free interval (SFI) and adverse events were collected. For patients with known surgical history before SISI, pre‐SISI SFI was compared. Institutional billing records and the national CMS average reimbursement were evaluated. Total charges for three treatment strategies (ED alone, ED with post‐operative SISI and primary intervention with SISI) were also compared.ResultsForty‐nine patients were included; 29 (59%) idiopathic, 11 (22%) traumatic and 9 (18%) rheumatologic. Mean (SD) follow‐up time after the first SISI was 3.41 years (1.5), range (2.08–7.25 years). 79% (39/49) did not require additional surgery during the entire follow‐up period. The SFI improved from a mean 13.5 months (SD 12.6; range 2–42 months) pre‐SISI to a mean (SD) of 42 months (SD 20.2; range 10–87 months) (p < 0.0001) after SISI. Annual average charges for ED alone in our cohort was $15,383.28, compared to $7,070.04 for SISI.ConclusionsSISI are an effective treatment for patients with SG/PTS. In‐office steroid injections could offer cost savings for the patient.Level of Evidence4 Laryngoscope, 133:2673–2679, 2023

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Office‐based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis

Abstract: 4. Laryngoscope, 128:2261-2267, 2018.

Cited by 12 publications

References 21 publications

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

National Database Outcomes of Esophageal Dilations

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

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