Findings from a recently published cross-sectional study of 45,156 patients with larynx cancer at 5516 hospitals across the U.S. show reduced odds of postoperative complications in patients who underwent laryngectomies in hospitals that, at a minimum, performed more than six laryngectomies per year. Hospitals that performed more had even better outcomes.
Hospitals considered very high volume (>28 cases per year) were linked to a higher reduction in the odds of in-hospital mortality, postoperative surgical complications, and acute medical complications. In addition, very high-volume hospitals saw reductions in length of hospitalization (mean of -3.7 days) and hospital-related costs (-$4,777.00) compared to low volume hospitals.
“The biggest implication of these data are for large health systems,” said lead author of the study, Christine G. Gourin, MD, MPH, professor of otolaryngology–head and neck surgery at Johns Hopkins School of Medicine in Baltimore. “Within a large healthcare system, particularly in metropolitan or urban areas, regionalization of high-risk, low-volume procedures makes sense.”
Nitin A. Pagedar, MD, MPH, director of the division of head and neck surgery in the department of otolaryngology–head and neck surgery at the University of Iowa in Iowa City, who wrote an accompanying commentary to the study, said that the most important take away message of the study is that “patients without barriers to getting a high-volume center may be best served going to such a center for laryngectomy.”
Further research is needed, Dr. Gourin said, “to identify the factors that lie behind the volume relationship to determine if any of these can be exported to lower-volume centers.”
One factor that is known, she said, is that failure-to-rescue is lower in high volume head and neck surgical care compared to low volume hospitals.
What is not known, said Dr. Pagedar, are the patient factors that may influence the better outcomes in high-volume hospitals. He pointed out that the benefits seen by the patients at high-volume centers in the study may not necessarily reflect what these centers are doing differently than low-volume centers but may reflect patient factors that are more common at these high-volume centers.
“While we tried to control for patient complexity, we were restricted to administrative codes and so cannot capture stage, patient selection, or patient preferences, all of which can influence patient selection and outcomes,” said Dr. Gourin. However, she pointed out that she and her colleagues have previously shown that high-volume hospital surgical care for larynx cancer patients who are elderly is associated with higher-quality treatment and surgical performance (Laryngoscope. 2014;124:2049–2056).