The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer

Chun Hsien Ho; Sheng Dean Luo; Wei Chih Chen; Tai Jan Chiu; Yu Ming Wang; Shao Chun Wu; Yao Hsu Yang; Shau Hsuan Li; Spencer Chia Hao Kuo; Ching Nung Wu

doi:10.1007/s00405-024-08727-5

The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer

Chun Hsien Ho, Sheng Dean Luo, Wei Chih Chen, Tai Jan Chiu, Yu Ming Wang, Shao Chun Wu, Yao Hsu Yang, Shau Hsuan Li, Spencer Chia Hao Kuo, Ching Nung Wu^*

^*Corresponding author for this work

School of Traditional Chinese Medicine

Research output: Contribution to journal › Journal Article › peer-review

Abstract

BACKGROUND: Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients.

METHODS: A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis.

RESULTS: Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders.

CONCLUSIONS: Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.

Original language	English
Pages (from-to)	4983-4990
Number of pages	8
Journal	European Archives of Oto-Rhino-Laryngology
Volume	281
Issue number	9
Early online date	17 05 2024
DOIs	https://doi.org/10.1007/s00405-024-08727-5
State	Published - 09 2024

Bibliographical note

Keywords

Albumin
Free flap complications
Hypopharyngeal cancer
Medical expenditures
Humans
Middle Aged
Risk Factors
Male
Free Tissue Flaps/economics
Case-Control Studies
Hypopharyngeal Neoplasms/surgery
Health Care Costs
Postoperative Complications/economics
Taiwan
Adult
Female
Aged
Retrospective Studies
Reoperation/economics
Plastic Surgery Procedures/economics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00405-024-08727-5

Cite this

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title = "The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer",

abstract = "BACKGROUND: Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients.METHODS: A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis.RESULTS: Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders.CONCLUSIONS: Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.",

keywords = "Albumin, Free flap complications, Hypopharyngeal cancer, Medical expenditures, Humans, Middle Aged, Risk Factors, Male, Free Tissue Flaps/economics, Case-Control Studies, Hypopharyngeal Neoplasms/surgery, Health Care Costs, Postoperative Complications/economics, Taiwan, Adult, Female, Aged, Retrospective Studies, Reoperation/economics, Plastic Surgery Procedures/economics",

author = "Ho, {Chun Hsien} and Luo, {Sheng Dean} and Chen, {Wei Chih} and Chiu, {Tai Jan} and Wang, {Yu Ming} and Wu, {Shao Chun} and Yang, {Yao Hsu} and Li, {Shau Hsuan} and Kuo, {Spencer Chia Hao} and Wu, {Ching Nung}",

note = "{\textcopyright} 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2024",

month = sep,

doi = "10.1007/s00405-024-08727-5",

language = "英语",

volume = "281",

pages = "4983--4990",

journal = "European Archives of Oto-Rhino-Laryngology",

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T1 - The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer

AU - Ho, Chun Hsien

AU - Luo, Sheng Dean

AU - Chen, Wei Chih

AU - Chiu, Tai Jan

AU - Wang, Yu Ming

AU - Wu, Shao Chun

AU - Yang, Yao Hsu

AU - Li, Shau Hsuan

AU - Kuo, Spencer Chia Hao

AU - Wu, Ching Nung

PY - 2024/9

Y1 - 2024/9

N2 - BACKGROUND: Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients.METHODS: A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis.RESULTS: Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders.CONCLUSIONS: Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.

AB - BACKGROUND: Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients.METHODS: A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis.RESULTS: Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders.CONCLUSIONS: Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.

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KW - Case-Control Studies

KW - Hypopharyngeal Neoplasms/surgery

KW - Health Care Costs

KW - Postoperative Complications/economics

KW - Taiwan

KW - Adult

KW - Female

KW - Aged

KW - Retrospective Studies

KW - Reoperation/economics

KW - Plastic Surgery Procedures/economics

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DO - 10.1007/s00405-024-08727-5

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AN - SCOPUS:85193710041

SN - 0937-4477

VL - 281

SP - 4983

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JO - European Archives of Oto-Rhino-Laryngology

JF - European Archives of Oto-Rhino-Laryngology

IS - 9

ER -

The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer

Abstract

Bibliographical note

Keywords

UN SDGs

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