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Total Laryngectomy Length of Stay Association With Diagnosis Related Group Classification
Trisha Shang1, Claudia I Cabrera1,2, Rachel A Kominsky3
1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Objective:
With increased nationwide emphasis on high-value care and cost reduction, more attention has been paid to postoperative outcomes. In this study, we examined if diagnosis related group (DRG) classifications could be used to predict total laryngectomy (TL) length of stay (LOS) which could help with determining areas for improved resource allocation.
Methods:
This is a retrospective study at a single tertiary academic center of TL patients between January 2013 and December 2020. For each DRG, we compared the primary outcome of LOS and secondarily examined perioperative outcomes, including complications and readmissions. We used Kruskal-Wallis tests to assess perioperative outcome and LOS differences among DRGs' correlation. Furthermore, we used public data to determine annual geometric means LOS (GMLOS) for TLs and compared this to institutional LOS.
Results:
The 211 patients were included. Patients with more severe DRG classification had greater LOS (p = 0.004). Fistula complications occurred at higher rates in more severe DRG classification, with major complication or comorbidity (MCC) at 25.0%, CC at 16.9%, and without complication or comorbidity (CC)/MCC at 3.1%, p = 0.02. The 30-day readmission was more common in MCC (26%) compared to CC (8.4%) or without CC/MCC (9.4%), p < 0.01. We found higher GMLOS compared to institutional LOS for TLs.
Conclusion:
TL patients with CC and MCC have longer LOS than those without CC/MCC, as well as higher fistula and readmission rates. DRGs can be used to identify areas to improve resource allocation for patients that may have poorer post-TL outcomes.
