Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dartmouth Medical School, Hanover, NH, USA.
Otolaryngol Head Neck Surg. 2012 Jul;147(1):85-90. doi: 10.1177/0194599812438170. Epub 2012 Feb 27.
To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment.
Population-based cohort study.
Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges.
All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge.
Between 1997 and 2008, the number of laryngectomies done in the United States decreased by 48%. New cases of laryngeal cancer decreased 33% during the same time. The proportion of patients older than 65 years decreased from 48% to 43%. Mortality for the procedure was 1.4% in 1997 and 1.1% in 2008. Mean length of stay over the study period increased from 13 days to 14 days. Mean hospital charges rose from $58,000 in 1997 to $109,000 in 2008, consistent with the overall rise in US health care costs. Medicare was the dominant insurer throughout. Home health was ordered in 50% of 2008 discharges but only 32% in 1997.
The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped, consistent with the trend toward nonsurgical treatment. Lower surgical volumes and/or salvage laryngectomy surgeries are hypothesized to play a role in longer length of stay, stable mortality rates despite younger patient age, and increased need for home services after discharge.
描述美国全喉切除术卫生服务利用的时间趋势，如手术率、成本、住院时间和保险支付者，并将其与喉癌治疗建议的重要里程碑进行比较。
基于人群的队列研究。
医疗保健成本和利用项目-全国住院患者样本（HCUP-NIS）1997-2008 年：美国所有医院出院患者的分层样本。
所有主要手术为全喉切除术的患者。分析单位是出院。
1997 年至 2008 年间，美国全喉切除术数量减少了 48%。同期喉癌新发病例减少了 33%。65 岁以上患者的比例从 48%降至 43%。该手术的死亡率从 1997 年的 1.4%降至 2008 年的 1.1%。研究期间，平均住院时间从 13 天增加到 14 天。平均医院费用从 1997 年的 58000 美元增加到 2008 年的 109000 美元，与美国医疗保健成本的整体增长一致。医疗保险一直是主要的保险公司。2008 年出院的 50%患者接受了家庭健康护理，但 1997 年只有 32%。
全喉切除术的比例下降超过了喉癌的发病率下降，这与非手术治疗的趋势一致。较低的手术量和/或挽救性喉切除术手术被认为是导致住院时间延长、尽管患者年龄较小但死亡率稳定以及出院后对家庭服务需求增加的原因。
