Medialization laryngoplasty/arytenoid adduction: U.S. outcomes, discharge status, and utilization trends. (22nd November 2018)

• Record Type: Journal Article
• Authors: Ekbom, Dale C.; Orbelo, Diana M.; Sangaralingham, Lindsey R.; Mwangi, Raphael; Van Houten, Holly K.; Balakrishnan, Karthik
• Is Part Of: Laryngoscope. Volume 129:Number 4(2019)
• Page Start: 952
• Page End: 960
• Publication Date: 2018-11-22
• Subjects: Medialization laryngoplasty -- type I thyroplasty -- arytenoid adduction -- outcomes -- utilization -- national database; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.27538
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: To evaluate trends, outcomes, and healthcare utilization following medialization laryngoplasty (ML) with or without arytenoid adduction (AA) over 10 years. Study Design: Retrospective observational study. Methods: Using OptumLabs Data Warehouse, trends, outcomes, and healthcare utilization from 2006 to 2015 were examined with a focus on discharge type (same day or not). Predictors of postoperative emergency department (ED) use and hospitalization were determined by multivariable logistic regression. Results: Overall rate of ML was 1.09 per 100 thousand enrollees per year. Of these, 7.8% ML were combined with an AA. Outpatient same‐day discharge represented 62.0% (1, 142 of 1, 843) of total patients, steadily increasing over the 10‐year period ( P < 0.01). There was a 5.9% revision ML rate and 1.0% rate of tracheotomy within 1 day of ML. A total of 5.6% visited an ED, and 5.4% were admitted to a hospital following initial discharge within 30 days. Same‐day discharge was found to be a predictor of hospitalization within 30 days after ML (odds ratio [OR] 1.74, P = 0.0452), along with Elixhauser comorbidity index of 4 + (OR 5.74, P = 0.0001). Pulmonary embolism, pulmonary hypertension, and weight loss were top predictors of ED visit or hospitalization. Conclusion: To our knowledge, this is the first search evaluating national claims data for ML with or without AA. Overall rate of ML is low, and same‐day discharge has become more common over a 10‐year period, with an associated higher 30‐day hospital admission risk. Correct patient selection criteria for disposition status cannot be fully determined based on current data, but a high Elixhauser comorbidity index clearly carries increased risk for hospitalization after initial discharge. Level of Evidence: 4 Laryngoscope, 129:952–960, 2019