Office-based vs. operating room-performed laryngopharyngeal surgery: a review of cost differences

Abstract

Purpose: Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings.

Methods: PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed.

Results: Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial.

Conclusion: Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.

Keywords: Cost-effectiveness; Costs; Larynx surgery; Office-based; Operating room; Pharynx surgery; Topical anesthesia.

Fig. 1

Flow chart of study selection

Fig. 2

Hospital costs (with and without physician fees) for office-based and OR-performed procedures in Euros per procedure

Fig. 3

Hospital charges (with and without physician fees) for office-based and OR-performed procedures in Euros per procedure

Fig. 4

Physician fees for office-based and OR-performed procedures in Euros per procedure