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The effect of transoral robotic surgery on short-term outcomes and cost of care after oropharyngeal cancer surgery

Authors

  • Jeremy D. Richmon MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
    • Send correspondence to Jeremy D. Richmon, MD, FACS, Johns Hopkins Outpatient Center, Department of Otolaryngology–Head and Neck Surgery, 601 N. Caroline Street, Baltimore, MD 21287. E-mail: jrichmo7@jhmi.edu

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  • Harry Quon MD, MS,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
    2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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  • Christine G. Gourin MD, MPH

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Transoral surgery is an increasingly frequent treatment modality for tumors of the upper aerodigestive tract. This is in large part related to the introduction of transoral robotic surgery (TORS) for oropharyngeal cancer resection, which has demonstrated excellent oncologic and functional outcomes. There is limited data, however, on how TORS compares to traditional open surgery in overall costs and length of hospitalization. With increasing pressure to contain and reduce the costs of medical care, we sought to evaluate the impact of TORS on a national sample of patients undergoing surgery for oropharyngeal cancer.

Study Design

Retrospective cross-sectional study.

Methods

A cross-sectional analysis of 9,601 patients who underwent an extirpative procedure for a malignant oropharyngeal neoplasm in 2008 to 2009 was performed using discharge data from the Nationwide Inpatient Sample.

Results

TORS was performed in 116 (1.2%) of cases. TORS patients had a lower rate of gastrostomy tube placement (0% vs. 19%), tracheotomy tube placement (0% vs. 36%), and nonroutine discharge (0% vs. 44%) compared to patients undergoing non-TORS procedures. After controlling for all other variables, including comorbidity, extent of surgery, and teaching hospital status, TORS was associated with significantly decreased length of hospitalization (mean, −1.5 days) and hospital-related costs (mean, −$4,285).

Conclusions

TORS is becoming an increasingly frequent technique to treat tumors of the upper aerodigestive tract. These data demonstrate that TORS is associated with a decreased length of hospitalization and hospital-related costs compared to other surgical techniques.

Level of Evidence

2c. Laryngoscope, 124:165–171, 2014

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