Study design: Cross-sectional ecological study; regression analysis used for some statistics.
Explore this issue:
March 2013Setting: Boston University; University of California, San Diego.
Synopsis: The primary clinical outcomes were mortality, mortality index, length of stay (LOS), LOS index, complication rate, cost and cost index. Results came from 93 hospitals. A majority of patient statistics came from white males aged 52 and older. High-volume medical centers had a higher proportion of patients 65 and older, fewer black and Hispanic patients, more patients with private insurance, a lower mean admission cost, a lower complication rate after controlling for other factors and more comorbidities but a lower use of ICU and substantially lower LOS and LOS index compared with low-volume centers. Moderate-volume centers also had a higher proportion of patients aged 65 and older, saw more severe cases, treated more patients on Medicare and worked with more comorbidities. Low-volume centers had a higher proportion of patients aged 31 to 64, saw more minor cases and had a higher cost index. LOS, cost, mortality rate and mortality index were not significantly different across centers. Study drawbacks included a lack of individual patient data, mortality and morbidity calculated from in-hospital discharge data, unrecorded pre-operative and readmission costs and no long-term follow up data available.
Bottom line: There is evidence of an association between increased volume and lower complications at medical centers that offer head and neck surgery. More physicians, better staffed surgical floors and ICUs and better equipment may contribute to these findings.
Citation: Jalisi S, Bearelly S, Abdillahi A, Truong MT. Outcomes in head and neck oncologic surgery at academic medical centers in the United States. Laryngoscope. 2013;123:689-698.
—Reviewed by Amy Eckner