Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis

Objective To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. Methods A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. Results Preoperative radiotherapy (p= 0.007), method of wound closure (p< 0.001), postoperative serum albumin level (p= 0.025), and postoperative serum hemoglobin level (p= 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163;p= 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917;p= 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p< 0.001), preoperative serum albumin level (p= 0.04), postoperative serum albumin level (p< 0.001), and history of liver cirrhosis (p= 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093;p= 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156;p= 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis. Conclusions Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.