Trends in Total Laryngectomy in the Era of Organ Preservation

OBJECTIVE: To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment. STUDY DESIGN: Population-based cohort study. SETTING: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges. SUBJECTS AND METHODS: All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge. RESULTS: Between 1997 and 2008, the number of laryngectomies done in the United States decreased by 48%. New cases of laryngeal cancer decreased 33% during the same time. The proportion of patients older than 65 years decreased from 48% to 43%. Mortality for the procedure was 1. 4% in 1997 and 1. 1% in 2008. Mean length of stay over the study period increased from 13 days to 14 days. Mean hospital charges rose from 58, 000 in 1997 to 109, 000 in 2008, consistent with the overall rise in US health care costs. Medicare was the dominant insurer throughout. Home health was ordered in 50% of 2008 discharges but only 32% in 1997. CONCLUSIONS: The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped, consistent with the trend toward nonsurgical treatment. Lower surgical volumes and/or salvage laryngectomy surgeries are hypothesized to play a role in longer length of stay, stable mortality rates despite younger patient age, and increased need for home services after discharge.