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. 2025 Jun;51(6):109634.
doi: 10.1016/j.ejso.2025.109634. Epub 2025 Jan 28.

Determinants of a longer length of stay in major head and neck cancer surgery: A national study based on the French hospital discharge database

Alessandra Zago  1 , Aline Augustynen  2 , Franchel Raïs Obongo-Anga  3 , Agnès Loeb  2 , Véronique Merle  4 , Thomas Vermeulin  5
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Determinants of a longer length of stay in major head and neck cancer surgery: A national study based on the French hospital discharge database

Alessandra Zago et al. Eur J Surg Oncol. 2025 Jun.

Abstract

Background: In many countries where hospitals are funded by a prospective payment scheme based on Diagnosis Related Groups (DRG), two risks may arise whenever legitimate extra costs are not considered: patient selection and/or lower care quality. We aimed to analyse determinants of an increased length of stay (LOS) used as a proxy for costs, in major head and neck cancer surgery.

Methods: We selected all hospitalisations in France between 2015 and 2021 classified in the DRG « Major head and neck surgery », with a main diagnosis of cancer. We analysed determinants of the LOS using a multivariate linear model.

Results: We analysed 19380 stays. We found several factors associated with increased LOS, that are not taken into account in the hospital funding scheme: complexity of surgical procedures, type of admission, patients' comorbidities.

Conclusions: Some of these factors should be considered in the hospital funding model.

Keywords: Head and neck cancer (HNC); Health economics; Hospital funding; Length of stay (LOS); Surgical oncology.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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