(0698) Parotidectomy Trends Toward Outpatient for Benign Disease: Do Patients and Providers Benefit?

Introduction: Management of benign parotid tumors is constantly evolving; this study was performed to identify temporal trends in outpatient vs inpatient parotidectomy and compare outcomes during a 5-year period.

Methods: A retrospective review of patients who underwent parotidectomy from 2018-2022 in a single tertiary-care institution was performed. Patients were excluded if they had preoperative malignant lesions. We analyzed perioperative outcomes between outpatients and inpatients as well as the cost comparison within our institution.

Results: There were 370 parotidectomies performed; pleomorphic adenoma was the most common histology (n = 187, 50.5%), followed by Warthin’s tumor (n = 56, 15.1%). After the Covid pandemic in March 2020, there was a significant trend towards outpatient parotidectomy (n = 125, 72.7%) compared to the years prior (n = 97, 48.9%) (p < 0.001). Patients were significantly more likely to be selected for inpatient if they had heart disease (57.1% vs 42.9%, p = 0.027), older average age T(368) = 3.4, p = 0.008, or requiring total parotidectomy (57.4% vs 42.6%, p = 0.006). Significantly more patients converted from a planned inpatient procedure to outpatient, than from outpatient to inpatient (17.8% vs 6.8%, p = 0.002). Inpatient parotidectomies were found to have greater blood loss T(359) = 5.1, p< 0.001 and surgery time T(358) = 11, p < 0.001. There was no significant difference in total or medical complications. Using our fiscal 2023 billing data, the average outpatient parotidectomy at our main hospital for a benign tumor saved patients' $2,886.96 when compared to overnight admission ($10,346.94, n = 1, inpatient vs $7,459.98, n = 41, outpatient). At our outpatient surgery center the average parotidectomy costs $5,170.35.38 (n = 9).

Conclusions: At our institution there was a major shift after the COVID pandemic to outpatient parotidectomy for benign tumors. Our cohort demonstrates that outpatient parotidectomy can safely be performed without increased complications. Further, we demonstrate outpatient parotidectomies are more efficient use of hospital resources and more cost effective for the patient.