title: Transoral robotic surgery for oropharyngeal and tongue cancer in the United States.
abstract: OBJECTIVE
  To compare the clinical and cost outcomes of transoral robotic surgery (TORS) versus open procedures following the U.S. Food and Drug Administration approval in December 2009.
  
  
  METHODS
  Retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2011.
  
  
  METHODS
  Elective partial pharyngectomies and partial glossectomies for neoplasm were identified by International Classification of Diseases, 9th Revision, Clinical Modification code.
  
  
  RESULTS
  TORS represented 2.1% in 2010 and 2.2% in 2011 of all transoral ablative procedures. Patients undergoing open partial pharyngectomy for oropharyngeal neoplasms (n = 1426) had more severe illness compared to TORS (n = 641). However, after controlling for minor-to-moderate severity of illness, open partial pharyngectomy was associated with longer hospital stay (5.2 vs. 3.7 days, P < 0.001), higher charge ($98,228 vs. $67,317, P < 0.001), higher cost ($29,365 vs. $20,706, P < 0.001), higher rates of tracheostomy and gastrostomy tube placement, and more wound and bleeding complications. TORS was associated with a higher rate of dysphagia (19.5% vs. 8.0%, P < 0.001). The lower cost of TORS remained significant in the major-to-extreme severity of illness group but was associated with higher complication rates when compared to open cases of the same severity of illness. A similar analysis of TORS partial glossectomy for base of tongue tumors had similar cost and length of stay benefits, whereas TORS partial glossectomy for anterior tongue tumors revealed longer hospital stays and no benefit in charge or cost compared to open.
  
  
  CONCLUSIONS
  Early data demonstrate a clinical and cost benefit in TORS partial pharyngectomy and partial glossectomy for the base of tongue but no benefit in partial glossectomy of the anterior tongue. It is likely that anatomic accessibility and extent of surgery factor into the effectiveness of TORS.
authors.affiliation: Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Chung
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D005927:Glossectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D010611:Pharyngectomy / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D014062:Tongue Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D014481:United States
keywords: Transoral robotic surgery; cost analysis; glossectomy; nationwide inpatient sample; oropharyngeal cancer; pharyngectomy; robotic surgery; tongue cancer
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