title: Primary payer status, individual patient characteristics, and hospital-level factors affecting length of stay and total cost of hospitalization in total laryngectomy.
abstract: Medicaid and uninsured patients anecdotally incur higher cost and length of stay because of nonmedical, discharge-related factors. The purpose of this study was to investigate the association between primary payer and length of stay and cost, controlling for comorbidities and complications, in patients undergoing total laryngectomy.
  
  
  
  The sample included 4128 patients who underwent total laryngectomy in the 2005 to 2010 National Inpatient Sample (NIS). Patients were categorized into 4 subgroups based on payer status: Medicare, Medicaid, uninsured, and private insurance. Using multilevel modeling, we examined differences in length of stay and hospitalization costs.
  
  
  
  The odds of being in the top quartile of length of stay increased for Medicaid patients by 41% (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.03-1.92) compared with privately insured patients.
  
  
  
  After controlling for medical factors, Medicaid patients had increased lengths of stay. Overall costs were highest for those with public insurance, but no difference was seen for the adjusted cost. © 2016 Wiley Periodicals, Inc. Head Neck 39: 311-319, 2017.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health - Shreveport, Shreveport, Louisiana.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: José M
authors.initials: JM
authors.lastname: Flores
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health - Shreveport, Shreveport, Louisiana.
authors.forename: Richard Will
authors.initials: RW
authors.lastname: Thompson
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health - Shreveport, Shreveport, Louisiana.
authors.forename: Cherie-Ann
authors.initials: CA
authors.lastname: Nathan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000639:trends; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000601:surgery; D007825:Laryngectomy / Q000191:economics* / Q000379:methods*; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
keywords: Medicaid; bundled payments; hospital costs; laryngectomy; length of stay