title: Trends and the utilization of transoral robotic surgery with neck dissection in New York State.
abstract: The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS.
  
  
  
  We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence.
  
  
  
  Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts.
  
  
  
  Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02).
  
  
  
  Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology.
  
  
  
  2c. Laryngoscope, 127:1571-1576, 2017.
authors.affiliation: Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Frenkel
authors.affiliation: Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Mengru
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Elliot
authors.initials: E
authors.lastname: Regenbogen
authors.affiliation: Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, U.S.A.
authors.forename: Ghassan J
authors.initials: GJ
authors.lastname: Samara
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D037981:Neck Dissection / Q000706:statistics & numerical data* / Q000639:trends*; D009518:New York; D010039:Otorhinolaryngologic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D014600:Utilization Review
keywords: SPARCS; TORS; neck dissection; robotic; transoral