Öz
Aim: COVID pandemic forced new medical protocols. COVID precautions also changed surgical algorithms causing a change in medical costs. This study aims to clarify COVID-era medical costs and underlying reasons for patients with Head & Neck (H&N) area skin tumors.
Materials and Methods: Patients which were operated for H&N tumors in our clinic before and during the COVID outbreak were retrospectively analyzed per sex, age, etiology, PPE usage, treatments, and total costs. Statistical analysis was done for any significant changes.
Results: A total of 127 patients of which 70 were operated before (G1) and 57 were operated after (G2) the COVID out-break for H&N tumors were evaluated. Mean ages were 69,94 years for G1 and 65,56 for G2. 28 BCC and 42 SCC patients were in G1 and 11 BCC and 46 SCC patients were in G2. In G1, 69 wide excisions, 44 skin graft, 17 skin flaps, 6 lymph node dissections (LNDs) were done. In G2, 56 wide excisions, 30 skin grafts, 9 skin flaps, 6 LNDs, 5 free flaps were done. G1 patients were hospitalized for a median of 2 days, while G2 patients were hospitalized for a median of 3 days. Median costs were 261,42inG1and261,42inG1and624.84 in G2. Statistical analysis with Mann-Whitney-U and Chi-Square tests revealed significant difference only between the costs. When disposable PPE was excluded, the median cost of G2 became $539.84 (G3). Statistical difference between G1 and G3 was found to be insignificant.
Conclusion: COVID changed the etiology of our patient groups. However, our treatment protocols, hospitalization lengths, and costs remain the same. Our patient profile and treatment protocols remain similar, but COVID precautions add an extra burden.
Anahtar Kelimeler
Kaynakça
- Riva F, Kerawala C. Maxillofacial services in the COVID-19 (SARS-CoV-2) pandemic – early lessons from the Italian experience. British Journal of Oral and Maxillofacial Surgery. 2020; 58 (January): 744-5.
- Sawhney C, Singh Y, Jain K, Sawhney R, Trikha A. Trauma care and COVID-19 pandemic. Journal of Anaesthesiology Clinical Pharmacology. 2020; 36 (S.1): 115-20. doi:10.1136/rapm
- Dash S, Das R, Saha S, Singhal M. Plastic surgeons and COVID-19 pandemic. Indian Journal of Plastic Surgery. 2020; 53 (2): 191-7. doi:10.1055/s-0040-1715531
- Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. Journal of Cranio-Maxillofacial Surgery. 2020; 48 (5): 521-6. doi:10.1016/j.jcms.2020.03.011
- Kaye AD, Okeagu CN, Pham AD, Silva RA, Hurley JJ, Arron BL, Sarfraz N, Lee HN, Ghali GE, Gamble JW, Liu H, Urman RD, Cornett EM. Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Pract Res Clin Anaesthesiol. 2021 Oct;35(3):293-306. doi: 10.1016/j.bpa.2020.11.009. Epub 2020 Nov 17. PMID: 34511220; PMCID: PMC7670225.
- Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. Journal of Cranio-Maxillo-Facial Surgery. 2020; 48 (January): 521-6.
- Brar B, Bayoumy M, Salama A, Henry A, Chigurupati R. A survey assessing the early effects of COVID-19 pandemic on oral and maxillofacial surgery training programs. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021; 131 (1): 27-42. doi:10.1016/j.oooo.2020.08.012
- Jayakar R, Choi J, Mackinnon C, Tan S. The cost of major head and neck cancer surgery. New Zealand Medical Journal. 2017; 130 (1455): 111-9.
- Chen JT, Kempton SJ, Rao VK. The Economics of Skin Cancer. Plastic and Reconstructive Surgery - Global Open. 2016; 4 (9): e868. doi:10.1097/GOX.0000000000000826
- Wissinger E, Griebsch I, Lungershausen J, Foster T, Pashos CL. The Economic Burden of Head and Neck Cancer: A Systematic Literature Review. PharmacoEconomics. 2014; 32 (9): 865-82. doi:10.1007/s40273-014-0169-3
Öz
Amaç: COVID salgını yeni tıbbi protokolleri zorunlu kılmıştır. COVID önlemleri, cerrahi algoritmaları da tıbbi maliyetlerde bir değişikliğe neden olacak şekilde değiştirmiştir. Bu çalışma, Baş ve Boyun (H&N) bölgesi deri tümörü olan hastaların COVID dönemindeki tıbbi maliyetleri ve altta yatan nedenleri açıklığa kavuşturmayı amaçlamaktadır.
Gereç ve Yöntem: Kliniğimizde COVID salgını öncesi ve sırasında H&N tümörleri nedeniyle ameliyat edilen hastalar cinsiyet, yaş, etiyoloji, PPE kullanımı, tedaviler ve toplam maliyetlere göre geriye dönük olarak analiz edildi. Önemli değişiklikler için istatistiksel analiz yapıldı.
Tartışma: COVID, hasta gruplarımızın etiyolojisini değiştirmiştir. Ancak tedavi protokollerimiz, hastanede kalma sürelerimiz ve maliyetlerimiz aynı kalmıştır. Hasta profilimiz ve tedavi protokollerimiz benzer olup, yalnızca COVID önlemleri maliyete fazladan yüke sebep olmaktadır.
Sonuç: 70'i COVID salgını öncesi (G1) ve 57'si COVID salgın başlangıcı sonrası ameliyat edilmiş (G2) olmak üzere toplam 127 H&N tümörlü hasta değerlendirildi. Ortalama yaş G1 için 69,94 ve G2 için 65,56 idi. G1’de 28 BCC ve 42 SCC hastası, G2’de 11 BCC ve 46 SCC hastası olduğu görüldü.
G1'de 69 geniş eksizyon, 44 deri grefti, 17 deri flebi, 6 lenf nodu diseksiyonu (LND) hastası mevcuttu. G2'de 56 geniş eksizyon, 30 deri grefti, 9 cilt flebi, 6 LND, 5 serbest flep hastası mevcuttu. G1 hastalarının ortalama 2 gün hastanede kaldığı, G2’deki hastaların ise ortalama 3 gün hastanede kaldığı görüldü. Ortalama maliyetler G1'de 299,66veG2′de625,91veG2′de625,91 idi. Mann-Whitney-U (MWU testi) ve Ki-kare testiyle yapılan istatistiksel analizde, etiyolojiler ve maliyetler arasında önemli bir fark olduğu görüldü. PPE hariç tutulduğunda ise (G3), ortalama maliyet 539,84$ (G3) oldu. G1 ve G3 arasındaki farkın ise, MWU testiyle istatistiksel anlamsız olduğu bulundu.
Anahtar Kelimeler
Kaynakça
- Riva F, Kerawala C. Maxillofacial services in the COVID-19 (SARS-CoV-2) pandemic – early lessons from the Italian experience. British Journal of Oral and Maxillofacial Surgery. 2020; 58 (January): 744-5.
- Sawhney C, Singh Y, Jain K, Sawhney R, Trikha A. Trauma care and COVID-19 pandemic. Journal of Anaesthesiology Clinical Pharmacology. 2020; 36 (S.1): 115-20. doi:10.1136/rapm
- Dash S, Das R, Saha S, Singhal M. Plastic surgeons and COVID-19 pandemic. Indian Journal of Plastic Surgery. 2020; 53 (2): 191-7. doi:10.1055/s-0040-1715531
- Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. Journal of Cranio-Maxillofacial Surgery. 2020; 48 (5): 521-6. doi:10.1016/j.jcms.2020.03.011
- Kaye AD, Okeagu CN, Pham AD, Silva RA, Hurley JJ, Arron BL, Sarfraz N, Lee HN, Ghali GE, Gamble JW, Liu H, Urman RD, Cornett EM. Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Pract Res Clin Anaesthesiol. 2021 Oct;35(3):293-306. doi: 10.1016/j.bpa.2020.11.009. Epub 2020 Nov 17. PMID: 34511220; PMCID: PMC7670225.
- Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. Journal of Cranio-Maxillo-Facial Surgery. 2020; 48 (January): 521-6.
- Brar B, Bayoumy M, Salama A, Henry A, Chigurupati R. A survey assessing the early effects of COVID-19 pandemic on oral and maxillofacial surgery training programs. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021; 131 (1): 27-42. doi:10.1016/j.oooo.2020.08.012
- Jayakar R, Choi J, Mackinnon C, Tan S. The cost of major head and neck cancer surgery. New Zealand Medical Journal. 2017; 130 (1455): 111-9.
- Chen JT, Kempton SJ, Rao VK. The Economics of Skin Cancer. Plastic and Reconstructive Surgery - Global Open. 2016; 4 (9): e868. doi:10.1097/GOX.0000000000000826
- Wissinger E, Griebsch I, Lungershausen J, Foster T, Pashos CL. The Economic Burden of Head and Neck Cancer: A Systematic Literature Review. PharmacoEconomics. 2014; 32 (9): 865-82. doi:10.1007/s40273-014-0169-3
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Gönderilme Tarihi | 24 Haziran 2021 |
| Yayımlandığı Sayı | Yıl 2022 |