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Related Concept Videos

Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
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Non-Intubated Video-Assisted Thoracoscopic Surgery
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Application of Time-Driven Activity-Based Costing for Protocol-Driven Adult Open Airway Reconstruction.

Andrew D P Prince1, Fatameh Ramazani1, Robbi A Kupfer1

  • 1Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 10, 2026
PubMed
Summary

Open airway reconstruction for benign airway stenosis is resource-intensive, with intensive care unit (ICU) care being the main cost driver. Time-driven activity-based costing (TDABC) helps identify optimization opportunities in complex airway surgery.

Keywords:
airway reconstructionhealthcare economicsperioperative efficiencyprotocolized caretime‐driven activity‐based costingvalue‐based care

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Area of Science:

  • Surgical Innovation
  • Health Economics
  • Airway Management

Background:

  • Benign airway stenosis requires complex surgical management.
  • Understanding resource utilization is crucial for optimizing care delivery.

Purpose of the Study:

  • To describe a protocol-driven approach for adult open airway reconstruction.
  • To apply time-driven activity-based costing (TDABC) to characterize resource use and cost drivers in these procedures.

Main Methods:

  • Retrospective cohort study of adult patients undergoing tracheal resection (TR) or cricotracheal resection (CTR).
  • Multidisciplinary process mapping using a modified Delphi technique.
  • Application of TDABC methodology to analyze costs across the operative admission.

Main Results:

  • Twenty patients underwent airway reconstruction (13 TR, 5 CTR, 2 revision CTR).
  • Total cost of care was $135,598.08 ± $25,100, with intensive care unit (ICU) care comprising 60.5%.
  • ICU length of stay and nursing labor were significant cost drivers (P < .05).

Conclusions:

  • Protocol-driven open airway reconstruction is resource-intensive.
  • Postoperative ICU care is the primary cost driver.
  • TDABC offers a framework for understanding costs and optimizing value-based care in complex airway surgery.