Operating Room Versus Office‐Based Injection Laryngoplasty: A Comparative Analysis of Reimbursement

Bové, Michiel; Jabbour, Noel; Krishna, Priya; Flaherty, Kathi; Saul, Melissa; Wunar, Robert; Rosen, Clark A.

doi:10.1097/01.mlg.0000250898.82268.39

Cited by 93 publications

(19 citation statements)

References 11 publications

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“…Pointing to the popularity of this technique, a recent multi-institutional review revealed that VFI was performed equally often in an awake patient as one under general anesthesia (3). VFI in the awake setting has the distinct advantages of providing direct feedback of vocal fold closure and voice outcome during the injection, avoiding limitations of difficult exposure, and avoiding general anesthesia with its inherent risks and increased cost (4). Technical successes, as well as voice outcomes, as measured by standardized patient-based voice surveys, are similar to injection performed under general anesthesia when performed by an experienced laryngologist (4, 5).…”

Section: Injection Approachesmentioning

confidence: 99%

“…VFI in the awake setting has the distinct advantages of providing direct feedback of vocal fold closure and voice outcome during the injection, avoiding limitations of difficult exposure, and avoiding general anesthesia with its inherent risks and increased cost (4). Technical successes, as well as voice outcomes, as measured by standardized patient-based voice surveys, are similar to injection performed under general anesthesia when performed by an experienced laryngologist (4, 5). Patient selection is critical when choosing VFI in an awake patient; a cooperative, calm patient without a strong gag reflex is required for successful completion.…”

Section: Injection Approachesmentioning

confidence: 99%

“…Ease of performing the procedure with limited experience is greater in the case of vocal fold injection performed under general anesthesia, when compared with laryngeal framework surgery. Finally, significant cost benefit has been found in the case of in-office awake injection when compared to those performed in the operating room (4). …”

Section: Indicationsmentioning

confidence: 99%

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Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

Mallur

Rosen

2010

Clin Exp Otorhinolaryngol

Self Cite

194

214

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Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar). A review of materials available and different vocal fold injection approaches is performed. A comparison of vocal fold injection to laryngeal framework surgery is also undertaken. With proper patient and material selection, vocal fold injection now plays a major role in the treatment of many patients with dysphonia.

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Section: Injection Approachesmentioning

confidence: 99%

Section: Injection Approachesmentioning

confidence: 99%

See 1 more Smart Citation

Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

Mallur

Rosen

2010

Clin Exp Otorhinolaryngol

Self Cite

194

214

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“…Correspondingly to other minimal invasive surgical treatment methods, transoral injection laryngoplasty under local anaesthesia has proved to be a safe and cost-effective method [ 21 – 23 ]. According to Bove et al , the average reimbursement for injection laryngoplasty under general anaesthesia was $ 2 505 and $ 496 for office-based injection laryngoplasty videosurgery [ 21 ], which showed the financial effectiveness of the second approach procedure. In this study 13 patients were discharged home on the day of the procedure, which significantly reduced hospital charges.…”

Section: Discussionmentioning

confidence: 99%

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes.

Sielska-Badurek

Sobol

Jędra

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionInjection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office.AimTo evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis.Material and methodsFourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32–83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient.ResultsAfter injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life.ConclusionsThe transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection.

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“…Naidu et el showed that in-office cup biopsies of laryngopharyngeal tumour are safe and considerably more cost-effective compared to the performance in operating room under general anaesthesia [19] . Similarly, Bové et al demonstrated that office-based injection laryngoplasty is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency [20] . Our study showed a little but statistically insignificant increase in absolute number of head and neck surgeries performed in local anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

Goranović

Šimunjak

Tonković

et al. 2014

JHA

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Objective: To analyze the impact of the hospital board's cost saving measure on physicians' decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods:Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure.Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions:The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board's cost saving measure did not have any impact on physicians' decisions to indicate more surgeries in local anaesthesia.

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Operating Room Versus Office‐Based Injection Laryngoplasty: A Comparative Analysis of Reimbursement

Abstract: Office-based IL is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency.

Cited by 93 publications

References 11 publications

Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes.

Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

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