Jasjit K. Dillon

The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging?

Background Nodal metastases and extracapsular extension (ECE) are important prognostic indicators. However, the diagnostic accuracy of CT is still limited for patients with clinically N0 neck. Purpose To determine the prevalence of lymph node (LN) metastases and ECE for oral cavity squamous cell carcinoma (SCC) patients with clinical and CT negative preoperative neck. Material and Methods Thirty-two patients with N0 oral cavity SCC who underwent neck dissection were included in this retrospective analysis. The size of LN was measured on transverse CT images, and radiological size criterion was based upon a minimal axial diameter of 10 mm. Pathology was used as the standard reference. Imaging and histopathological correlation was done for 132 LN levels in the 32 patients. Results Fourteen of 32 patients (44%) had metastatic nodes and six patients had ECE. Among 132 LN levels, 22 levels (17%) had metastatic LNs (level I 5/37, level II 8/39, level III 7/35, level IV 2/18), and eight of 22 levels with metastases had ECE. Poorly differentiated histology was a predictive factor for LN metastases or ECE (poorly versus well and moderately differentiated SCC: P = 0.07 for LN metastases and P = 0.08 for ECE, respectively). T-classification was also an important predictor for occult nodal metastases (2 of 10 patients in T1, 12 of 22 patients in T2–4), although it did not reach statistical significance (P = 0.11). Conclusion Diagnostic accuracy of CT is limited among N0 oral cavity SCC patients. Neck dissection should be performed, particularly for patients with poorly differentiated SCC or higher T-classification.

The cause of cost in the management of odontogenic infections 1: a demographic survey and multivariate analysis.

PURPOSE The purpose of this retrospective cohort study was to describe the demographics of patients with odontogenic infections and to evaluate the costs associated with the demographic, social, treatment, and hospital course variables in patients hospitalized for odontogenic infections. MATERIALS AND METHODS A retrospective chart review was conducted in patients admitted for odontogenic infections at Harborview Medical Center from July 1, 2001, through June 30, 2011. RESULTS In total, 318 patient charts were reviewed and included. The unsponsored portion of the patient population increased from 14.7-61.9% over the course of the study. The average hospital bill per patient in this study was

The Financial Burden of Mandibular Trauma

17,053. Of the

Analysis of Clinical Prognostic Factors for Adult Patients with Head and Neck Sarcomas

5,422,854 billed, only

A rare occurrence of hepatocellular carcinoma metastasis to the mandible: report of a case and review of the literature.

1,528,869 was received by the hospital in payment for services rendered, equating to

Can progression of odontogenic infections to cervical necrotizing soft tissue infections be predicted

3,893,985 in lost potential revenue. The variables location of treatment, length of stay, length of stay in the intensive care unit, additional use of the operating room, and antibiotic regimen accounted for 90.2% of the variation in the hospital bill. CONCLUSION Unsponsored patients constituting 61.9% of the patient population represent an enormous challenge for hospitals and providers. To maintain the standard of care for all patients and still be able to provide care to patients without insurance, county hospitals and academic institutions must seek to improve cost efficiency. The present findings reinforce the need to be vigilant about the decision to admit, take to the operating room, admit to an intensive care unit, and discharge to lower the costs to the patient, hospital, and society for the management of odontogenic infections.

The cause of cost in the management of odontogenic infections 2: multivariate outcome analyses.

PURPOSE Patients with mandibular trauma in the greater Seattle region are frequently transferred to Harborview Medical Center (HMC) despite trained providers in the surrounding communities. HMC receives poor reimbursement for these services, creating a disproportionate financial burden on the hospital. In this study we aim to identify the variables associated with increased cost of care, measure the relative financial impact of these variables, and quantify the revenue loss incurred from the treatment of isolated mandibular fractures. MATERIALS AND METHODS A retrospective chart review was conducted of patients treated at HMC for isolated mandibular fractures from July 1999 through June 2010, using International Classification of Diseases, Ninth Revision and Current Procedural Terminology coding. Data collected included demographics, injury, hospital course, treatment, outcomes, and billing. RESULTS The study included 1,554 patients. Total billing was

Exsanguinating Hemorrhage Following Third Molar Extraction: Report of a Case and Discussion of Materials and Methods in Selective Embolization

22.1 million. Of this,

Navigational Surgery and Computer Assisted Treatment Planning

6.9 million was recovered. We found that there are multiple variables associated with the increased cost of treating mandibular fractures; 4 variables--length of hospital stay, treatment modality, service providing treatment, and method of arrival--accounted for 49.1% of the total variance in the amount billed. In addition, we found that the unsponsored portion of our patient population grew from 6.7% to 51.4% during the study period. CONCLUSIONS Our results led to specific cost-efficiency recommendations: 1) perform closed reduction whenever possible; 2) encourage performing procedures with patients under local anesthesia (closed reductions and arch bar removals); 3) provide improved and shared training among the services treating craniofacial trauma; 4) encourage arrival by privately owned vehicle; 5) provide outpatient treatment, when applicable; 6) offer provider incentives to take trauma call; and 7) offer hospital incentives to treat patients and not transfer them.

Lip Cancer: General Considerations

Objective To evaluate the treatment, outcome, and prognostic factors in patients with head and neck sarcomas treated in an academic medical center. Study Design Case series. Setting Academic medical center. Subjects and Methods We performed a retrospective analysis of adult patients (n = 97) with primary head and neck sarcomas treated between 2000 and 2012. We analyzed the treatment, outcome, and potential factors predictive of disease-free survival and disease-specific survival. We also evaluated the outcome and prognostic factors in patients with bone and soft tissue sarcomas. Results The median overall survival was 6.8 years, with 2-year and 5-year overall survival rates of 78% (95% confidence interval [CI], 66%-86%) and 59% (95% CI, 44%-72%), respectively. Univariable analysis revealed that age at diagnosis (>60 years: hazard ratio [HR], 2.7; 95% CI, 1.2-6.2; P = .01), surgical intervention (HR, 8.3; 95% CI, 3.5-19.5; P < .001), and metastatic disease (HR, 4.3; 95% CI, 1.3-13.6; P = .01) were significantly associated with disease-specific survival. Conclusion In this study, patients over the age of 60 years at diagnosis and those with inoperable disease at initial presentation had significantly worse disease-specific survival. Surgical intervention remains the optimal treatment modality for those with resectable disease and was associated with significantly better survival in this heterogeneous series. Further multi-institutional studies are required to better define prognostic factors in individual histological subtypes.