title: Laryngeal Preservation in Glottic Cancer: A Comparison of Hospital Charges and Morbidity among Treatment Options.
abstract: When total laryngectomy is not required, organ preservation surgery or radiotherapy is considered the standard of care for primary glottic cancer. These accepted treatment options are available for early and advanced glottic cancers due to equivalent locoregional control and survival rates. However, in today's climate of accountable care, the financial burden of treatment choices continues to increase in significance. We therefore compared hospital charges and treatment-related morbidity between organ-preserving surgery and radiation with or without chemotherapy-herein, (chemo)radiation-in the primary treatment of glottic cancer.
  
  
  
  Nationwide Inpatient Sample Database was analyzed to assess clinical and financial information.
  
  
  
  Population-based analysis.
  
  
  
  Patients (N = 5499) with primary glottic cancer undergoing treatment with laryngeal preservation strategies.
  
  
  
  Patients were subdivided by ICD-9 codes into 3 treatment groups: endoscopic resection, open partial laryngectomy, and (chemo)radiation. Treatment-related outcomes, charges, and length of hospitalization were analyzed among treatment groups.
  
  
  
  When adjusting for sex, age, race, comorbidity, and primary payer, (chemo)radiotherapy was associated with increased direct charges (P < .001; coefficient, $23,658.99; 95% confidence interval [95% CI]: $10,227.15-$37,090.84) and length of hospitalization (P < .001; hazard ratio, 0.593; 95% CI: 0.502-0.702) when compared with endoscopic surgery. As compared with open surgery, endoscopic surgery was associated with reduced hospital charges (P = .012; coefficient, $11,967.01; 95% CI: $2,784.17-$21,249.85) and duration of hospitalization (P < .001; hazard ratio, 0.749; 95% CI: 0.641-0.876).
  
  
  
  This analysis suggests that increased utilization of endoscopic surgery in patients with primary glottic cancer not requiring total laryngectomy may lead to reduced financial burden and duration of hospitalization when compared with open surgery or (chemo)radiation therapy.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Mandelbaum
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Abemayor
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA AMendelsohn@mednet.ucla.edu.
authors.forename: Abie H
authors.initials: AH
authors.lastname: Mendelsohn
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005931:Glottis / Q000473:pathology*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: cancer; cost; cost-effectiveness; endoscopic; hospital charges; larynx; morbidity; radiation