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

Abstract

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.

Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

“…1,2 A multitude of benefits are well established, primarily relating to minimized morbidity, patient inconvenience, and associated costs of theater-based surgery under general anesthesia. [3][4][5] A range of lasers are currently used in TNFLS, primarily photoangiolytic varieties such as the 585 nm pulsed-dye laser (PDL) 1,6 and the 532 nm potassium titanyl phosphate (KTP) laser, 7 the latter being the most widely studied and utilized. 7 The use of cutting lasers such as the 10 600 nm CO 2 laser 8 remains limited in the office setting due to its comparatively expensive flexible glass fibers and poorer coagulation profile.…”

In-Office Needle Arthroscopy for Anterior Ankle Impingement

“…Previous literature has primarily focused on the diagnostic use of IONA compared to MRI. 11 , 12 , 13 , 14 , 15 McMillan et al. retrospectively reviewed 175 knee and 25 shoulder in-office nano-arthroscopic procedures and compared reimbursement for the IONA to the cost of the MRI for diagnosis.…”

In Vitro Evaluation of Biomaterials for Vocal Fold Injection: A Systematic Review

“…Young recurrent laryngeal nerve (RLN) tissue appeared more elastic to strain, while adolescent RLN tissue was stiffer and tended to break with strain [ 5 ]. In treating glottic insufficiency, vocal fold injection is preferred as it is more cost-effective and time-saving [ 6 , 7 ]. Currently available biomaterials for vocal fold injection include bovine and porcine gelatin, carboxymethylcellulose, calcium hydroxylapatite (CaHA), autologous fat, collagen-based and hyaluronic acid (HA)-based hydrogels [ 8 ].…”