Trends of Total Laryngectomy: Analysis of California Patient Discharge Data 1996‐2010

Abstract

Objectives: Determine if the number of total laryngectomies (TL) performed in California has changed over the last fifteen years. We also sought to investigate if the location of surgery, length of stay, and use of rotational/free flaps changed over this time period. Methods: All patient records enlisting ICD-9-CM procedural codes for laryngectomy were extracted from the California Patient Discharge Data sets of 1996-2010. Patients’ demographics were evaluated. Teaching otolaryngology hospitals were coded as academic. Population-adjusted surgery rates, percentage of surgeries with rotational/free flap and/or percutaneous endoscopic gastrostomy (PEG), length of stay, total charges, and disposition status were then analyzed and compared between academic and non-academic centers. Results: A total of 4,145 TLs were performed from 1996-2010. The overall number of surgeries declined from 1.3 surgeries per 100,000 California residents to 0.6 per 100,000 California residents. The number of surgeries performed in non-academic medical centers dropped by 70% during this time period ( P < .01). The median length of stay increased from 10 to 12 days, and the median total charges increased from $45000 to $192000 ( P < .01). The use of rotational/free flaps more than doubled, and the use of PEG tubes increased seven folds ( P < .01). Conclusions: The total number of patients undergoing TL in California has declined, and the surgery is increasingly being performed at academic medical centers. The use of rotational and free flaps has increased over the last 15 years.