Skip to main content
AAO-HNSF 2024 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back

Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 7 - Head and Neck Surgery

Postoperative Complications Impact Inpatient Facility Fees Following Free Tissue Transfer for Head and Neck Cancer

Monday, September 30, 2024
4:30 PM – 4:36 PM EDT
Location: MBCC, 208
Disclosure(s):
Zachary N. Goldberg, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sruti Tekumalla, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Keisha Arielle Best, MS, MSc:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Angela E. Alnemri, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Leila J. Mady, MD, PhD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Joseph M. Curry, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Head and neck cancer (HNC) is routinely treated with free tissue transfer (FTT) due to favorable functional and cosmetic outcomes. However, complications frequently occur, impacting overall cost of care. There is a gap in the literature related to understanding the greatest drivers of cost from complications following FTT for HNC.

Methods: This retrospective single-site cohort study analyzed a database of microvascular free-flap cases in HNC patients between 2018 and 2021. Direct itemized costs were obtained and categorized into 11 “cost buckets” via grouping of Universal Billing Codes (UBC). Univariable and multivariable regression analysis was employed to identify associations between complications and cost drivers. P-values were two-tailed, and significance was set to 0.05 alpha.

Results: A total of 204 patients were included in the study, and 61 patients had 97 total complications. There was a significant difference in total cost for patients with ≥1 complication vs patients without a complication ($34,783 vs $26,022; p< 0.001). There were significant differences in average cost in 9 of 11 cost buckets for patients with ≥1 complication compared to patients without a complication: ICU care ($11,813 vs $3,322; p = 0.007), Operating Room ($7,469 vs $6,726); p = 0.021), Pharmacy ($2,594 vs. $1,661; p = 0.002), Diagnostic Services ($2,046 vs $1,622; p = 0.007), Anesthesia ($1,787 vs. $1,615; p = 0.026), PT/OT/Speech ($670 vs $549; p = 0.02), Blood Bank ($662 vs. $413; p = 0.019), Misc. Costs ($2,139 vs $466; p = 0.013), and Recovery Room ($591 vs. $451; p = 0.008). Total cost significantly increased when one of the following occurred: ≥1 medical complication(s) (p < 0.001), total flap loss (p < 0.001), partial flap necrosis (p = 0.023), fistula (p = 0.024), deep venous thrombosis (p = 0.049), or myocardial infarction (p < 0.001).

Conclusions: Medical or surgical complications following FTT significantly increased total cost of care and nearly all grouped cost buckets compared to cases without complications. Given the substantial costs associated with complications, investment in programs to minimize them is warranted.

    Presenting Author(s)

  • Zachary N. Goldberg, MD

    Resident Physician
    Boston University Medical Center
    Boston, MA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Amiti Jain

    Medical Student
    Thomas Jefferson University - Sidney Kimmel Medical College
    Philadelphia, PA, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • Sruti Tekumalla, BA

    Medical Student
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia , Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • RW

    Richard Wu, MD

    Head and Neck Institute, Cleveland Clinic, United States

    Disclosure information not submitted.

  • Keisha Arielle Best, MS, MSc

    Medical Student
    Wayne State University School of Medicine
    Wyandotte, MI, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Ramez Phillips, MD

    Medical Student
    Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

    Disclosure information not submitted.

  • Angela E. Alnemri, MD

    Resident Physician
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Leila J. Mady, MD, PhD, MPH

    Assistant Professor
    Johns Hopkins University
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • RG

    Richard A. Goldman, MD

    Associate Professor
    Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, PA, United States

    Disclosure information not submitted.

  • Joseph M. Curry, MD

    Professor
    Thomas Jefferson University
    Wynnewood, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.