Short-term outcomes and cost of care of treatment of head and neck paragangliomas

Abstract

Objectives/hypothesis: To characterize contemporary treatment of head and neck paragangliomas and the effect of treatment on postoperative complications, length of stay, and costs.

Study design: Retrospective cross-sectional study.

Methods: Discharge data from the Nationwide Inpatient Sample for 7,791 patients who underwent endovascular or surgical treatment of head and neck paragangliomas between 1993 and 2008 were analyzed using cross tabulations and multivariate regression modeling.

Results: Surgery only was performed in 91% of cases, embolization alone was performed in 4% of cases, and both embolization and surgery were performed in 5% of cases. Postoperative surgical complications were significantly more likely in patients undergoing embolization and surgery during the same admission (odds ratio [OR], 2.3; P = .031), whereas acute medical complications were more likely in patients undergoing embolization only (OR, 3.9; P = .001). Embolization alone was specifically associated with an increased risk of acute renal failure (OR, 8.2; P = .026) and pneumonia (OR, 3.9; P = .001). Cranial nerve injury was associated with increased odds of dysphagia (OR, 8.5; P = .004), and dysphagia was associated with increased odds of voice disturbance (OR, 5.1; P = .004). Embolization, with or without surgery during the same admission, was associated with significantly increased hospital-related costs, after controlling for all other variables.

Conclusions: Endovascular treatment of head and neck paragangliomas is associated with an increase in complications and hospital-related costs. Although these findings may reflect larger tumor size and comorbidity in patients selected for embolization, these data suggest a need to reexamine the benefits and cost-effectiveness of embolization in surgical patients.