Demographics and Trends in Outpatient Surgery for Early Glottic Cancer: 2016–2020

Introduction: Minimally invasive surgical approaches including transoral laser microsurgery (TLM) are being increasingly utilized for treatment of early glottic cancers. They have been found to improve organ preservation rates and are less costly compared to radiation therapy. Our study aims to elucidate characteristics of the population undergoing surgery for early glottic cancers in the United States, assessing the procedural costs and patient demographics to evaluate disparities in health care access.

Methods: A retrospective cohort study was conducted using the National Ambulatory Surgery Sample (NASS). Encounters for glottic cancers were identified by ICD codes C32.0, C32.1, C32.8, C32.9, and associated with CPT codes 31599, 31541, 31300, 31367, representing rigid laryngoscopic excisional procedures.

Analyses over the 2016-2020 period were centered on demographics (age, race, sex, location, median household income, payor) and procedural costs, providing a comprehensive overview of the current state of surgical treatment for glottic cancers.

Results: Of 7,062 procedures, 5,807 (82.2%) were male, with a mean patient age of 67.5 years. In 2019-2020 when race data was collected, 75.6% of 2,913 patients were White. Most procedures were performed in metropolitan areas with a population exceeding 1 million (27.3%). The payor mix was dominated by Medicare (45.6%) and private insurance (31.4%). In contrast, only 696 (9.9%) of procedures were performed on rural patients, and 551 (7.8%) of procedures were covered by Medicaid. In 2019-2020, Black and Hispanic patients made up only 295 (10.1%) and 201 (6.9%), respectively.

Conclusions: Our findings suggest that the population more likely to undergo these procedures is predominantly male and White, with most residing in urban areas. The equitable distribution of charges across income quartiles contrasts with the demographic skewness, suggesting economic factors are not the sole determinant of access. Strategies must be developed to improve early cancer detection in under-represented populations and expand access to facilities that offer minimally invasive treatments.