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Factors Associated With Head and Neck Cancer Hospitalization Cost and Length of Stay—A National Study

Adjei Boakye, Eric, PhD*,†; Johnston, Kenton J., PhD*,†; Moulin, Thiago A., MD*; Buchanan, Paula M., PhD, MPH*; Hinyard, Leslie, PhD, MSW*; Tobo, Betelihem B., PhD, MPH; Massa, Sean T., MD§; Osazuwa-Peters, Nosayaba, BDS, PhD, MPH, CHES‡,§,∥

American Journal of Clinical Oncology: February 2019 - Volume 42 - Issue 2 - p 172–178
doi: 10.1097/COC.0000000000000487
Original Articles: Head and Neck

Objectives: The aim of the study was to estimate hospitalization cost, and factors associated with hospitalization costs and length of stay (LOS) of patients treated for head and neck cancer in the United States.

Methods: Data on 71,440 weighted hospital admissions from the 2014 National Inpatient Sample with a diagnosis of head and neck cancer were examined. Multivariable linear regression models estimated factors associated with hospitalization costs, and negative binomial regression models were used to identify factors associated with hospital LOS. Factor variables included characteristics of the patient, clinical, and hospital characteristics.

Results: The average hospitalization cost was US $18,371 and the average LOS was 6.6 days. LOS was significantly associated with admissions involving bacterial infection, major operating procedures, chemo procedure, and radiation procedure as well as admissions at medium or small bed size hospitals, and rural hospitals. Admissions among black patients, elective admissions, admissions involving bacterial infection, major operating procedures, chemo procedure, radiation procedure, and advance comorbidities were associated with increased hospitalization costs. In contrast, admissions at urban nonteaching or rural had increased hospitalization costs.

Conclusions: Admissions that involve higher number of comorbidities, metastasis, bacterial infection, radiation, and chemo procedures had longer hospital stay and higher cost whereas admissions are rural hospitals had shorter hospital stay and lower cost. Understanding these factors associated with increased LOS and hospitalization cost will help efforts to decrease health care cost and improve quality of care.

*Saint Louis University Center for Health Outcomes Research (SLUCOR)

Department of Health Management and Policy

Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice

§Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine

Saint Louis University Cancer Center, St. Louis, MO

The authors declare no conflicts of interest.

Reprints: Eric Adjei Boakye, PhD, Saint Louis University Center for Health Outcomes Research (SLUCOR), 3545 Lafayette Avenue, 4th Floor, Salus Center, Saint Louis, MO 63104-1314. E-mail:

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