Premium
Trends and the utilization of transoral robotic surgery with neck dissection in New York State
Author(s) -
Frenkel Catherine H.,
Yang Jie,
Zhang Mengru,
Regenbogen Elliot,
Telem Dana A.,
Samara Ghassan J.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26345
Subject(s) - transoral robotic surgery , medicine , neck dissection , robotic surgery , dissection (medical) , general surgery , surgery , cancer
Objectives 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. Study Design 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. Methods 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. Results 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). Conclusion 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. Level of Evidence 2c. Laryngoscope , 127:1571–1576, 2017