title: The Effect of tumor subsite on short-term outcomes and costs of care after oral cancer surgery.
abstract: OBJECTIVE
  To determine if epidemiologic differences exist between patients with oral tongue carcinoma compared to tumors arising from other oral cavity subsites, and the relationship between primary site and in-hospital mortality, postoperative complications, length of stay, and costs in patients undergoing surgery for oral cavity cancer.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  The Nationwide Inpatient Sample was analyzed for patients who underwent an ablative procedure for a malignant oral cavity neoplasm in 2001 to 2008 using cross-tabulations and multivariate regression modeling.
  
  
  RESULTS
  Overall, there were 45,071 patients treated surgically for oral cavity cancer, with oral tongue cancer comprising 35% of all oral cavity tumors. Patients with oral tongue cancer were significantly more likely to be female (odds ratio [OR] = 1.4) and undergo neck dissection (OR = 1.4), and significantly less likely to be black (OR = 0.4), over 40 years of age (OR = 0.4), have Medicaid payer status (OR = 0.7), advanced comorbidity (OR = 0.7), receive care at a teaching hospital (OR = 0.5), and undergo pedicled or free flap reconstruction (OR = 0.6, P < .001). Oral tongue primary site was not associated with in-hospital mortality or surgical complications, but was significantly associated with a reduced incidence of medical complications (OR = 0.8, P = .005). After controlling for all other variables, oral tongue primary site disease was associated with a significantly reduced length of hospitalization and hospital-related costs.
  
  
  CONCLUSIONS
  Oral tongue cancer is associated with a distinct epidemiologic profile compared to other oral cavity cancer subsites, and is associated with lower postoperative morbidity, length of hospitalization, and hospital-related costs. Further investigation is warranted to determine if biologic factors underlie these observations.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Li
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Koch
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps