International Journal of Pediatric Otorhinolaryngology ( IF 1.5 ) Pub Date : 2021-08-05 , DOI: 10.1016/j.ijporl.2021.110871 Christopher Pool 1 , Christopher J Gates 2 , Vijay A Patel 3 , Michele M Carr 4
Background
Juvenile nasopharyngeal angiofibroma (JNA) is a locally aggressive benign vascular tumor that typically afflicts young adolescent males. Historically removed via open approaches, these tumors are now being removed endoscopically. As the modern healthcare setting emphasizes value, efficient utilization of resources may lead to decreased cost while maintaining or improving patient outcomes.
Objective
The objective of this study was to investigate how perioperative management of juvenile nasopharyngeal angiofibromas (JNAs) influence overall cost. We specifically investigate the effect of approach type (open, endoscopic, or combined) with regards to cost and length of stay. We also delineated practice patterns, analyzed safety profiles, and characterize clinical outcomes.
Methods
The 2016 Healthcare Cost and Utilization Project Kids’ Inpatient Database (HCUP-KID) was queried to identify males aged <21 years with an ICD-10-CM diagnosis code of D10.6 (benign neoplasm of nasopharynx) and ICD-10-PCS codes to determine whether an open, endoscopic or combined approach was performed. Univariate statistical analysis and multivariable logistic regression were performed to examine the effects of demographics, patient characteristics, procedure type, and complications on length of stay (LOS) and cost.
Results
A total of 89 male patients were analyzed with a mean age of 14.8 years (range 8–20 years). Mean LOS was 3.4 days. Mean total charges were $128,780. Comparing open (n = 16), endoscopic (n = 65), and combined (n = 8) approaches, there was a significant difference in the need for fresh frozen plasma (p = 0.02) and packed red blood cell (pRBC) (p = 0.03) transfusion but no difference in preoperative embolization (p > 0.05) between approach types. LOS was associated with age (p = 0.02), pRBC transfusion (p = 0.04) and septal deviation (p = 0.03). Charges varied with LOS (p < 0.001) on linear regression analysis but not with other variables in this dataset.
Conclusion
Approach type for JNA appears to be unrelated to LOS or charges in this multi-site, population-based analysis. However, septal deviation, pRBC transfusion, and young age are associated with increased LOS in patients undergoing JNA resection.
中文翻译:
青少年鼻咽血管纤维瘤:通过 HCUP KID 的国家实践模式和资源利用
背景
青少年鼻咽血管纤维瘤 (JNA) 是一种局部侵袭性良性血管肿瘤,通常折磨年轻的青春期男性。过去通过开放方法切除这些肿瘤,现在正在通过内窥镜切除。由于现代医疗保健环境强调价值,资源的有效利用可能会降低成本,同时保持或改善患者的治疗效果。
客观的
本研究的目的是调查青少年鼻咽血管纤维瘤 (JNA) 的围手术期管理如何影响总体成本。我们专门研究了入路类型(开放式、内窥镜式或组合式)对费用和住院时间的影响。我们还描述了实践模式,分析了安全性,并描述了临床结果。
方法
查询 2016 年医疗保健成本和利用项目儿童住院数据库 (HCUP-KID),以确定 ICD-10-CM 诊断代码为 D10.6(鼻咽良性肿瘤)和 ICD-10-PCS 的 <21 岁男性代码来确定是否进行了开放、内窥镜或组合方法。进行单变量统计分析和多变量逻辑回归以检查人口统计学、患者特征、手术类型和并发症对住院时间 (LOS) 和成本的影响。
结果
共分析了 89 名男性患者,平均年龄为 14.8 岁(范围 8-20 岁)。平均 LOS 为 3.4 天。平均总费用为 128,780 美元。比较开放 (n = 16)、内窥镜 (n = 65) 和联合 (n = 8) 方法,新鲜冷冻血浆 (p = 0.02) 和浓缩红细胞 (pRBC) 的需求存在显着差异( p = 0.03) 输血,但术前栓塞术无差异 (p > 0.05)。LOS 与年龄 (p = 0.02)、pRBC 输血 (p = 0.04) 和间隔偏差 (p = 0.03) 相关。费用随线性回归分析中的 LOS (p < 0.001) 而变化,但与此数据集中的其他变量无关。
结论
在这种基于人群的多站点分析中,JNA 的方法类型似乎与服务水平或费用无关。然而,在接受 JNA 切除术的患者中,间隔偏差、pRBC 输血和年轻与 LOS 增加有关。