Trends in Total Laryngectomy: A Population Based Study

Abstract

Objective: 1) Understand time trends in total laryngectomy rates across the US, including rates of surgery, cost, length of stay, teaching status, size of hospital, and insurance payer. 2) Understand what role the paradigm shift in primary treatment of laryngeal cancer may mean for surgical outcomes, cost, and length of stay.

Method: Population-based study from 1997 to 2008 utilizing the HCUP-NIS database: a stratified sample of all US hospital discharges. The sample was all patients who had a principal procedure of ICD-9 code 30.3 or 30.4 (complete or radical laryngectomy). The unit of analysis was census area: Northeast, South, Midwest, and West.

Results: The number of laryngectomies done in the US decreased by 32% during the study period. New cases of laryngeal cancer decreased 26% during the same time. The highest rate of laryngectomy is in the South, the lowest in the Midwest and West. Mortality for the procedure is highest in the Northeast: 2.1%. Mean length of stay over the study period increased from 12.7 days to 13.9 days. Length of stay is shortest in the South. Median hospital charges rose dramatically (in 2008 dollars), from $34,934 in 1997 to $61,507 in 2008. Medicare remains the dominant insurance source.

Conclusion: The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped—suggesting that larynx preservation treatment has become dominant. Some implications of this shift are previously unexplored. As the number of procedures drops, the utility of a detailed registry to track outcomes becomes even greater.