The Influence of Reconstructive Modality on Cost of Care in Head and Neck Oncologic Surgery

Petruzzelli, Guy J.; Brockenbrough, John; Vandevender, Darl; Creech, Steven

doi:10.1001/archotol.128.12.1377

Cited by 54 publications

(37 citation statements)

References 16 publications

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“…Hospital length of stay and ICU utilization were substantially increased in patients with perioperative complications. PETRUZZELLI et al concluded that intricate reconstructions are likely to involve greater utilization of hospital resrouces 14 . There was a marginal difference in length of stay between soft and bony reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Free-flap failures and complications in an American oral and maxillofacial surgery unit

Salama

McClure

Ord

et al. 2009

International Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Free-flap failures and complications in an American oral and maxillofacial surgery unit

Salama

McClure

Ord

et al. 2009

International Journal of Oral and Maxillofacial Surgery

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“…noted a cost difference in regards to reconstructive modality [21]. They found that flap closure had increases in cost and length of hospital stay when compared to primary closure [21]. Although, our study showed longer initial hospital stay (10 vs. 3 days) and higher rates of flap closures (83% vs. 55%, p = 0.003) in the SR group, there was no significant difference in initial cost ($96,163 vs. $79,216) when compared to IR.…”

Section: Discussionmentioning

confidence: 99%

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Naghavi

Gonzalez²,

Scott

et al. 2017

jcb

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PurposeAdjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methodsA retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.ResultsMedian follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).ConclusionsIn recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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Section: Discussionmentioning

confidence: 99%

“…For example, Petruzzelli et al noted a cost difference in regards to reconstructive modality [21]. They found that flap closure had increases in cost and length of hospital stay when compared to primary closure [21]. Although, our study showed longer initial hospital stay (10 vs. 3 days) and higher rates of flap closures (83% vs. 55%, p = 0.003) in the SR group, there was no significant difference in initial cost ($96,163 vs. $79,216) when compared to IR.…”

Section: Discussionmentioning

confidence: 99%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methods: A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.Results: Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).Conclusions: In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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The Influence of Reconstructive Modality on Cost of Care in Head and Neck Oncologic Surgery

Cited by 54 publications

References 16 publications

Free-flap failures and complications in an American oral and maxillofacial surgery unit

Free-flap failures and complications in an American oral and maxillofacial surgery unit

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

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