Abstract
Objective: 1) Compare the outcomes of 2 surgical modalities used to treat hypopharyngeal diverticulum and esophageal stenosis at the Medical University of South Carolina (MUSC) and analyze the economic efficiency of each. 2) Compare the MUSC experience with statewide treatment in South Carolina (SC) Medicare patients.
Method: Retrospective analysis was conducted of 50 patients treated at MUSC. The 2 approaches utilized were endoscopic laser diverticulotomy and transcervical open diverticulectomy with cricopharyngeal myotomy. SC Medicare data was collected for patients undergoing these procedures. Primary outcomes investigated were intraoperative complications, operative charge, hospital stay, and postoperative complications.
Results: Statistically significant differences between the 2 operative groups at MUSC were observed in length of stay (1.08 days endoscopic group and 4.75 days transcervical open group; P > .0001) and operative charge (US $ 2842 endoscopic and US$ 3425 transcervical; P > .0001). The perioperative complication and readmission rates were similar. The rate of reoperation was the same between the 2 groups; however, most of the patients who underwent transcervical open diverticulectomy were initially planned as endoscopic approaches. The Medicare data group differed significantly in length of hospital stay and patient charges compared to MUSC group.
Conclusion: The comparison of techniques reveals that long-term outcomes are similar, but the immediate postoperative sequelae of prolonged hospital stay and increased operative charge with transcervical open diverticulotomy is evident. Although further cost analysis is indicated, endoscopic laser diverticulotomy is a safe, cost effective alternative to transcervical open diverticulectomy.
Get full access to this article
View all access options for this article.