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Scientific Oral Presentations

Laryngology/Broncho-Esophagology

Session: Scientific Oral Presentation 3 - Laryngology/Broncho-Esophagology

Application of Time-Driven Activity-Based Costing for Protocol-Driven Complex Adult Airway Reconstruction

Monday, October 13, 2025
9:54 AM - 10:00 AM EDT
Location: 138
Disclosure(s):
Andrew D.P Prince, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: To outline protocol-driven complex adult airway reconstruction from diagnosis to follow-up at a high-volume center, applying time-driven activity-based costing methodology (TDABC) to characterize resource utilization and costs.

Methods: Retrospective cohort analysis of complex airway reconstruction procedures at a single tertiary academic medical center from 8/22-8/24. Multidisciplinary process mapping for management of adult complex airway reconstruction cases including tracheal resection (TR) and cricotracheal resection (CTR) using a modified Delphi technique. Validated TDABC methodology was applied across operative admission and global period. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and cost of care delivery.

Results: Among 20 cases of airway reconstruction, most patients were female (70%), with a mean age of 41 (±14.8), and Charlson Comorbidity Index of 1 (± 1.1). Etiologies for tracheal stenosis were prolonged intubation (n=7), previous tracheostomy (n=4), a combination of both (n=6), and idiopathic stenosis (n=3). TR was the most common procedure (n=13), followed by CTR (n=5) and revision CTR (n=2). Protocol-driven management included clinic eval, DLB, airway reconstruction, ICU management, post-op DLB, etc. Post-op complications included seroma, tracheitis, and hematoma, in 1 patient respectively. Sixteen patients required a single post-reconstruction airway procedure, three required multiple procedures, and one required none. One patient required tracheostomy at most recent follow-up. Total cost of care delivery was $135,598.08 ± 25,100 with ICU care accounting for 60.5% of costs. Multivariable analyses identified significant cost drivers including length of stay in ICU and nursing labor (p < 0.05), with operating room, time, supplies, and physician time accounting for only 10% of total costs.

Conclusions: Evidence-based complex airway reconstruction for tracheal stenosis is resource intensive to ensure safe, high-quality care delivery.

    Presenting Author(s)

  • AP

    Andrew D.P Prince, MD

    Otolaryngology Resident
    University of Michigan
    Ann Arbor, Michigan, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • FR

    Fatemeh Ramazani, MD, MMEd, FRCSC

    Resident
    University of Calgary, United States

    Disclosure information not submitted.

  • RK

    Robbi A. Kupfer, MD

    Associate Professor
    University of Michigan
    Ann Arbor, MI, United States

    Disclosure information not submitted.

  • Norman D. Hogikyan, MD FACS

    Associate Chair and Professor
    Department of Otolaryngology-Head and Neck Surgery University of Michigan
    Ann Arbor, MI, United States

    Disclosure information not submitted.

  • RM

    Robert J. Morrison, MD, FACS

    Associate Professor, Director of Quality and Outcomes
    University of Michigan
    Ann Arbor, MI, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • PY

    Pratyusha Yalamanchi, MD MBA

    Head and Neck and Microvascular Surgery Fellow
    Vanderbilt University Medical Center
    Rochester Hills, MI, United States

    Disclosure information not submitted.