Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis

Ming-Hsien Tsai; Hui-Ching Chuang; Yu-Tsai Lin; Hui Lu; Fu-Min Fang; Tai-Lin Huang; Tai-Jan Chiu; Shau-Hsuan Li; Chih-Yen Chien

doi:10.1371/journal.pone.0236122

Peer Review History

Original SubmissionJune 6, 2020
17 Jun 2020 Decision Letter - Giovanni Cammaroto, Editor PONE-D-20-17243 Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis PLOS ONE Dear Dr. Chien, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 01 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Specifically, please ensure that you have discussed whether all data/tissue samples were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information. 3. We noticed minor instances of text overlap with the following previous publication(s), which need to be addressed: (1) https://journals.sagepub.com/doi/10.1177/0194599810393117 (2) https://www.sciencedirect.com/science/article/abs/pii/S1368837509009877?via%3Dihub (3) https://www.tandfonline.com/doi/abs/10.1080/00016489.2018.1532108?journalCode=ioto20 (4) https://www.jstage.jst.go.jp/article/circj/82/10/82_CJ-18-0289/_article The text that needs to be addressed involves the Discussion section (lines 219-224, 235-237, 240-248, 255-265). In your revision please ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. 4. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: A well-written article. Results are very difficult to extrapolate, because as the authors highlight cost related to surgery varies according to each country. However, add interesting information in order to increase savings related to healthcare. Reviewer #2: please see attachment ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Carlos M Chiesa-Estomba Reviewer #2: Yes: Jerome R. Lechien [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PLOS ONE - June 13 2020.docx Attachment Submitted filename: rev comments.docx https://doi.org/10.1371/journal.pone.0236122.r001
Revision 1
26 Jun 2020 Author Response We sincerely appreciate the constructive comments by your esteemed reviewers and we believe it has enhanced the clarity of our work. We have made the changes accordingly, along with the point-by-point response below. Once again we thank the editorial board of PLOS ONE and we hope to see our work published in this prestigious journal in the near future. Many thanks Reply to reviewers’ comments To Reviewer #1: A well-written article. Results are very difficult to extrapolate, because as the authors highlight cost related to surgery varies according to each country. However, add interesting information in order to increase savings related to healthcare. Response: We thank the reviewer for this great point. It is true that different health care systems in different countries will affect the length of postoperative hospital stay and inpatient medical expenses after total laryngectomy. We add this in the discussion. (line 241-242) To Reviewer #2: The authors investigated the predictive factors of PO hospital stay & medical cost in patients who benefited from TL. They identified several factors associated with the PO hospital stay or medical cost, including postoperative Hb level, albumin, preoperative RT (salvage TL), cirrhosis history or wound closure method. The study is well-conducted and designed and helpful for OTOHNS surgeons. The paper is short and to-the-point, which is particularly important for a potential publication in the journal. Some point has however been addressed to improve the manuscript. Abstract: 1. Develop the method section: state the studied outcomes (preop RT, etc.). Response: We thank the reviewer for this suggestion. We added this description about studied outcomes in section of abstract. (line 7 - 12) Introduction: 2. To the point, well organized. Response: We thank the reviewer for your appreciation. Methods: 3. What were your indication to make a flap and which flap were used ? Specify the exclusion criteria. Response: Free flap transfer for pharyngeal defect reconstruction after total laryngectomy would be performed if pharyngeal defect couldn’t primarily close without tension. The flap was most often harvested from the anterolateral thigh (n=160) followed by the anteromedial thigh (n=5) in our cohort. Patients who received partial laryngectomy or partial laryngopharyngectomy or patient didn’t receive total laryngectomy surgical procedure in our hospital would be excluded from our study. We have also updated the manuscript in the section of Method. (line 67 - 71 and line 153 - 156). 4. Line 80: you already define BMI in the abbreviation (line 70), just keep in this line BMI. Response: We thank the reviewer for this insightful observation. We had change word from “Body mass index (BMI, kg/m2)” to “BMI”. (line 85) Results: 5. line 114 = the cost is presented in Taiwan money and U.S. dollar. Please, present in the brackets the Euro value for European Physicians. Thus, you cover both U.S. and Europe. Response: Thank you very much for this useful recommendation. We had added the information of Taiwan Dollar to Euro Exchange Rate in our revised manuscript. (line 122 - 123) 6. Briefly specify the RT protocol (number of Gy, fraction, etc.) Response: We thank the reviewer for this suggestion. The radiation technique for these patients was intensity-modulated radiation therapy (IMRT). The primary radiation dose was between 6,600 and 7,000 cGy (2 cGy/fraction). We had added this description in the section of Result. (line 149 - 150) Discussion: 7. Another biological point that is important to consider is the thyroid status. In practice, we usually observed that hypothyroidism patients have wound healing disorder and longer hospital stay. The lack of consideration of this point is a limitation that has to be addressed. Response: We thank the reviewer for this great point. In previous study, Rosko et al. described postoperative hypothyroidism independently predicts postoperative wound-healing complications including pharyngocutaneous fistula formation in patients who underwent salvage total larygectomy [1]. In our cohort, most patients lack of thyroid function status in laboratory exam before/after total laryngectomy. Only 10 patients (10/213=4.7%) had thyroid function status before total laryngectomy and all of them were in euthyroid status. In postoperative period, 41 patients (41/213=19.2%) had checked thyroid function status during the hospitalization. Of them, 20 patients were in euthyroid status, 15 patients were in clinical hypothyroidism (decreased serum free T4 level and elevated serum TSH level) and 6 patients were in subclinical hypothyroidism (elevated serum TSH level and normal serum free T4 level). All patients diagnosed with hypothyroidism had been immediately treated with thyroxine according to our guideline. We have performed additional subgroup analyses between different postoperative thyroid function status. The association between thyroid function status and our interested outcome, including postoperative hospital stay and inpatient medical cost was showed in Table A. The univariate analysis didn’t show significance. The reason may be (1) the small number (n=41) in this analysis and (2) temporary low thyroid functional level postoperatively, because thyroxine supplement had been prescribed after hypothyroidism diagnosed. We have also updated the manuscript to reflect these findings. (line 253 – 263, 286 – 287) 8. Develop the limitation paragraph, heterogeneity between patients (indication/tumor localization, RT) etc. that may consist of heterogeneity in the study. The inclusion of non-SCC (papillary thyroid) is another bias. Response: We thank the reviewer for this suggestion. We had added the limitation paragraph about this study in section of discussion (line 283 – 287) Conclusion: 9. Remove “in total”. The sentence could be: Previous RT history and postoperative lower albumin level significantly impact the length of hospital stay. Response: We thank the reviewer for this suggestion. We had changed this sentence in section of conclusion to “Previous RT history and postoperative lower albumin level significantly impact the length of hospital stay.” (line 290) Reference: 1. Rosko AJ, Birkeland AC, Bellile Eet al. Hypothyroidism and Wound Healing After Salvage Laryngectomy. Ann Surg Oncol 2018; 25:1288-1295. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0236122.r002
30 Jun 2020 Decision Letter - Giovanni Cammaroto, Editor Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis PONE-D-20-17243R1 Dear Dr. Chien, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Giovanni Cammaroto Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0236122.r003
Formally Accepted
6 Jul 2020 Acceptance Letter - Giovanni Cammaroto, Editor PONE-D-20-17243R1 Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis Dear Dr. Chien: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Giovanni Cammaroto Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0236122.r004

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