The Socioeconomic Impact of Revision Otologic Surgery

Abstract

Objective: To estimate the socioeconomic impact of revision canal wall down (CWD) mastoidectomy. Method: Retrospective chart analysis from our tertiary care medical center that evaluated all adult patients who underwent CWD mastoidectomy by the senior surgeon between 2006 to 2011. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery at state (Illinois) and national levels. Results: One hundred eighty-nine CWD mastoidectomies were reviewed, of which 89 were primary and 100 were revision procedures. The total charge for this group of revision cases was $2,783,700, and the net reimbursement (collections) was $843,245. Using Illinois Hospital Consortium data, the estimated cost of reimbursement for revision CWD mastoidectomy for 387 cases in FY 2011 was nearly $3.3 million. An additional $2160 per patient in lost wages was predicted to have been related to time away from work. The 9214 patients who underwent revision CWD mastoidectomy in the U.S. represented a national healthcare cost of roughly $80 million. Conclusion: Known causes for failed CWD mastoidectomy include inadequate meatoplasty, high facial ridge, and residual or recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, thereby resulting in a positive impact on the socioeconomic strain related to this procedure at local, state, and national levels.