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The economic impact of revision otologic surgery
Sahar Nadimi1, John P Leonetti, George Pontikis
1Department of Otolaryngology-Head and Neck Surgery, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
Insights
Revision otologic surgery, specifically canal-wall-down mastoidectomy, incurs substantial healthcare costs. Understanding failure factors can reduce revision rates and economic burden.
Area of Science:
- Otolaryngology
- Health Economics
Background:
- Revision otologic surgery, particularly canal-wall-down (CWD) mastoidectomy, represents a significant economic burden.
- Factors contributing to CWD mastoidectomy failure necessitate revision procedures, impacting patient and healthcare system finances.
Purpose of the Study:
- To estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy.
- To analyze institutional charges and collections for revision CWD mastoidectomies.
Main Methods:
- Retrospective chart analysis of 189 adult CWD mastoidectomies (100 revision cases).
- Extrapolation of institutional charges and collections to estimate state and national healthcare costs.
- Utilized Illinois Hospital Association data for fiscal year 2011.
Main Results:
- Total charges for revision cases were $2,783,700, with net reimbursement of $846,289 (30.4%).
- Estimated reimbursement for 387 revision CWD mastoidectomies in Illinois (FY2011) was nearly $3.3 million.
- Estimated national cost for 9,214 revision CWD mastoidectomies in 2011 was approximately $76 million.
Conclusions:
- Revision CWD mastoidectomy procedures impose a substantial economic strain on the healthcare system.
- Identifying and addressing causes of CWD mastoidectomy failure can mitigate the need for revision surgery.
- Reducing revision rates offers potential economic benefits at local, state, and national levels.
Abstract:
Revision otologic surgery places a significant economic burden on patients and the healthcare system. We conducted a retrospective chart analysis to estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy. We reviewed the medical records of all 189 adults who had undergone CWD mastoidectomy performed by the senior author between June 2006 and August 2011 at Loyola University Medical Center in Maywood, Ill. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery in Illinois and at the national level. Of the 189 CWD mastoidectomies, 89 were primary and 100 were revision procedures. The total charge for the revision cases was $2,783,700, and the net reimbursement (collections) was $846,289 (30.4%). Using Illinois Hospital Association data, we estimated that reimbursement for 387 revision CWD mastoidectomies that had been performed in fiscal year 2011 was nearly $3.3 million. By extrapolating our data to the national level, we estimated that 9,214 patients underwent revision CWD mastoidectomy in the United States during 2011, which cost the national healthcare system roughly $76 million, not including lost wages and productivity. Known causes of failed CWD mastoidectomies that often result in revision surgery include an inadequate meatoplasty, a facial ridge that is too high, residual diseased air cells, and recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, which could have a positive impact on the economic strain related to this procedure at the local, state, and national levels.
