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 [ABSTRACT FROM AUTHOR]