Inpatient and Postacute Care After Head and Neck Surgery Among Beneficiaries.

Introduction: Medicare Advantage (MA) enrollment has grown rapidly, yet its implications for resource use in complex head and neck cancer (HNC) surgery remain unclear. Methods: Using 2019-2023 Medicare Provider Analysis and Review data, we identified adults admitted with an HNC diagnosis who underwent a qualifying head and neck surgical procedure. We used 1:1 propensity score matching to balance MA and traditional fee-for-service (FFS) beneficiaries on demographics, comorbidity, region, and admitting diagnosis. Outcomes included index length of stay (LOS) and discharge destination (home, home with home health, skilled nursing facility/rehabilitation, or hospice). Negative binomial and multinomial logistic regression models were used to estimate associations between insurance type and LOS or discharge disposition. Results: The matched cohort included 4618 admissions (2309 MA; 2309 FFS). Mean LOS was similar for MA and FFS patients (7.1 vs. 7.3 days), and discharge destination distributions were not significantly different. MA admissions had lower observed frequencies of selected complex procedure categories, including reconstructive surgery, neck dissection, laryngectomy, and mandibulectomy. In procedure-adjusted sensitivity models, MA enrollment was not associated with LOS (rate ratio 0.99, 95% CI 0.94-1.03) or discharge destination. Conclusions: Among Medicare beneficiaries hospitalized for HNC surgery, short-term inpatient utilization during the index admission was similar for MA and FFS enrollees. MA admissions had lower observed frequencies of selected complex procedure categories; however, this finding should be interpreted as a difference in observed operative mix rather than direct evidence of reduced access. Further studies linking claims to tumor registry and hospital-level data are needed to determine whether these patterns reflect case mix, treatment selection, hospital networks, or access barriers. Level of Evidence: 3.