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Guy J. Petruzzelli, MBA,MD,PhD; John M. Brockenbrough, MD; Darl Vandevender, MD; Steven D. Creech, MS

Arch Otolaryngol Head Neck Surg. 2002;128:1377-1380.

Objective  To determine the differential costs of 3 reconstructive modalities in patients undergoing head and neck oncologic surgery.

Design  Cost-identification analysis.

Setting  Academic tertiary care medical center.

Methods  Retrospective review of 104 major head and neck resections involving primary tumors of the upper aerodigestive tract requiring a tracheotomy (primary hospital discharge, diagnosis related group 482 from the International Classification of Diseases, Ninth Revision, Clinical Modification) from July 2, 1999, through June 30, 2000. Patients were stratified by reconstruction modality: (1) microvascular free tissue transfer (MFFT), (2) pedicle myocutaneous flaps (PMF), and (3) primary reconstruction and/or skin graft (PR). Dependent variables included length of hospitalization, direct and indirect hospital costs, total hospital costs, the percentage of total costs attributable to direct costs, and the percentage of total costs attributable to indirect costs.

Results  No significant age differences existed among the 3 patient groups. Significant differences (Kruskal-Wallis) were observed for all variables. The PR group was compared with the PMF and MFFT groups. Total patient charges were greatest in the MFFT group (mean, $22 821.04) and least for the PR group (mean, $13 125.70). Length of stay was greatest in the PMF group (mean, 7.53 days) and shortest in the PR group (mean, 5.53 days).

Conclusions  Intricate reconstructions are frequently more times consuming than primary closure, and the additional surgical procedures are more likely to use more hospital resources. Efforts at providing superior functional outcomes must be balanced against increasing restrictions on the use of health care dollars. Careful evaluation of functional outcomes and quality of life will be required to justify the increased expenditure incurred when providing complex reconstructions.

From the Departments of Otolaryngology–Head & Neck Surgery and the Cardinal Bernardin Cancer Center, Head and Neck Oncology Program (Drs Petruzzelli and Brockenbrough), General Surgery, Section of Plastic and Reconstructive Surgery (Dr Vandevender), and the Cardinal Bernardin Cancer Center (Mr Creech), Loyola University Medical Center, Maywood, Ill.

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