Concentration of High-Cost Head and Neck Cancer Surgical Patients

Objective: Health care costs are disproportionately concentrated among a small number of patients. We sought to identify variables associated with high-cost patients and high hospital concentration of high-cost patients and to examine associations with short-term outcomes in head and neck cancer (HNCA) surgery. Study Design: The Nationwide Inpatient Sample was used to identify 170,577 patients who underwent HNCA surgery in 2001–2011. High-cost patients were defined as patients whose costs of care were in the top decile, and high-concentration hospitals were defined as those whose percentage of high-cost patients was in the top decile. Methods: Multivariable regression was used to evaluate associations between cost and patient and hospital variables, postoperative complications, and in-hospital mortality. Results: Costs associated with high-cost patients were 4.47-fold greater than the remaining 90% of patients. High-concentration hospitals treated 36% of all high-cost patients. High-cost patients were more likely to be non-white (OR = 2.08 [1.45–2.97]), have oral cavity cancer (OR = 1.21 [1.05–1.39]), advanced comorbidity (OR = 1.53 [1.31–1.77]), Medicaid (OR = 1.93 [1.62–2.31]) or self-pay payor status (OR = 1.72 [1.38–2.14]), income>50th percentile (OR = 1.25 [1.05–1.51]), undergo major procedures (OR = 3.52 [3.07–4.05]) and have non-routine discharge (OR = 7.50 [6.01–9.35]). High-concentration hospitals were more likely to be teaching hospitals (OR = 3.14 [1.64–6.05]) and less likely to be urban (OR = 0.20 [0.04–0.93]). After controlling for all other variables, high-cost patients were associated with an increased odds of mortality (OR = 8.00 [5.89–10.85]) and postoperative complications (OR = 5.88 [5.18–6.68]). High-concentration hospitals were associated with an increased odds of postoperative complications (OR = 1.31 [1.08–1.61]) but were not associated with increased mortality (OR = 0.98 [0.67–1.44]). Conclusions: High-cost HNCA surgical patients are associated with increased postoperative morbidity and mortality, and are disproportionately concentrated at teaching hospitals. Level of Evidence: 4 Laryngoscope, 134:4971–4978, 2024.