The Effect of tumor subsite on short-term outcomes and costs of care after oral cancer surgery

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
The Laryngoscope (Impact Factor: 2.14). 07/2013; 123(7). DOI: 10.1002/lary.23952
Source: PubMed


To determine if epidemiologic differences exist between patients with oral tongue carcinoma compared to tumors arising from other oral cavity subsites, and the relationship between primary site and in-hospital mortality, postoperative complications, length of stay, and costs in patients undergoing surgery for oral cavity cancer.
Retrospective cross-sectional study.
The Nationwide Inpatient Sample was analyzed for patients who underwent an ablative procedure for a malignant oral cavity neoplasm in 2001 to 2008 using cross-tabulations and multivariate regression modeling.
Overall, there were 45,071 patients treated surgically for oral cavity cancer, with oral tongue cancer comprising 35% of all oral cavity tumors. Patients with oral tongue cancer were significantly more likely to be female (odds ratio [OR] = 1.4) and undergo neck dissection (OR = 1.4), and significantly less likely to be black (OR = 0.4), over 40 years of age (OR = 0.4), have Medicaid payer status (OR = 0.7), advanced comorbidity (OR = 0.7), receive care at a teaching hospital (OR = 0.5), and undergo pedicled or free flap reconstruction (OR = 0.6, P < .001). Oral tongue primary site was not associated with in-hospital mortality or surgical complications, but was significantly associated with a reduced incidence of medical complications (OR = 0.8, P = .005). After controlling for all other variables, oral tongue primary site disease was associated with a significantly reduced length of hospitalization and hospital-related costs.
Oral tongue cancer is associated with a distinct epidemiologic profile compared to other oral cavity cancer subsites, and is associated with lower postoperative morbidity, length of hospitalization, and hospital-related costs. Further investigation is warranted to determine if biologic factors underlie these observations.
2c. Laryngoscope, 2013

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    • "Similarly, the Canadian study of patients with oral or oropharyngeal cancer found that free flap (C$23,600) and pedicled flap (C$20,400) surgery had comparable costs [62]. These costs are likely to vary by the location of the cancer; three US studies using the National Inpatient Sample database found that costs for pedicled or free flap reconstruction ranged from US$10,087 (2012 US$) for patients with an oral malignancy to US$22,679 (2011 US$) for HNC patients with any oropharyngeal cancer [29, 43, 56]. "
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