Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.
Cooper Medical School at Rowan University, Camden, New Jersey, USA.
Otolaryngol Head Neck Surg. 2023 Dec;169(6):1499-1505. doi: 10.1002/ohn.412. Epub 2023 Jul 9.
Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation.
Retrospective cohort analysis.
Academic tertiary-care center from May 2014 to September 2021.
In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints.
Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003).
Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.
全喉切除术后的语音康复对生活质量有重大影响。留置假体嗓音恢复提供了最佳效果；然而，这些设备的长期维护需要相当大的财务成本，而这些成本并非普遍由保险覆盖。本研究旨在分析社会经济因素与喉切除术后语音康复结果之间的关系。
回顾性队列分析。
2014 年 5 月至 2021 年 9 月，学术三级保健中心。
在接受全喉切除术的患者中，比较了术后第一年留置气管食管穿刺置管（TEP-VP）的发生率与家庭收入、人口统计学因素和疾病特征之间的关系。功能和维护结果是次要终点。
共纳入 77 例患者。45 例（58%）行留置 TEP-VP（41 例为原发性）。年收入超过 50k 美元的患者中有 89%接受了 TEP-VP，而年收入低于 50k 美元的患者中只有 35%接受了 TEP-VP。有商业保险的患者中有 85%接受了 TEP-VP，有医疗保险的患者中有 70%，有医疗补助的患者中有 42%，无保险的患者中有 0%。多变量分析显示，年收入超过 50k 美元是 TEP-VP 放置的预测因素（优势比：12.7 [2.45-65.8]，p=0.002）。社会经济群体之间的术后言语治疗和功能交流结果利用相似。12 例患者在第一年无法负担用品费用，保险（p=0.015）和收入状况（p=0.003）之间存在差异。
喉切除术后的嗓音和言语康复方面的差异可能不成比例地影响服务不足的患者。
