The authors have no financial disclosures for this article.
Head and Neck
Article first published online: 23 MAR 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 4, pages 746–752, April 2011
How to Cite
Gourin, C. G., Forastiere, A. A., Sanguineti, G., Marur, S., Koch, W. M. and Bristow, R. E. (2011), Impact of surgeon and hospital volume on short-term outcomes and cost of oropharyngeal cancer surgical care. The Laryngoscope, 121: 746–752. doi: 10.1002/lary.21456
The authors have no conflicts of interest to disclose.
- Issue published online: 23 MAR 2011
- Article first published online: 23 MAR 2011
- Manuscript Accepted: 25 OCT 2010
- Manuscript Received: 12 SEP 2010
- oropharyngeal neoplasms;
- squamous cell cancer;
- surgery, cost;
- Level of evidence: 2c
To evaluate the impact of surgeon and hospital case volume and other related variables on short-term outcomes after surgery for oropharyngeal cancer.
The Maryland Health Service Cost Review Commission database was queried for oropharyngeal cancer surgical case volumes from 1990 to 2009. Multivariable regression models were used to identify significant associations between surgeon and hospital case volume, as well as independent variables predictive of in-hospital death, postoperative wound complications, length of hospitalization, and hospital-related cost of care.
Overall, 1,534 oropharyngeal cancer surgeries were performed during the study period. Complete financial data was available for 1,482 oropharyngeal cancer surgeries, performed by 233 surgeons at 36 hospitals. The only independently significant factors associated with the risk of in-hospital death were an APR-DRG mortality risk score of 4 (odds ratio [OR] = 14.0, P < .001) and total glossectomy (OR = 5.6, P = .020). Wound fistula or dehiscence was associated with an increased mortality risk score (OR = 5.9, P < .001), total glossectomy (OR = 6.9, P < .001), mandibulectomy (OR = 3.4, P < .001), and flap reconstruction (OR = 2.1, P = .038). Increased mortality risk score, total glossectomy, pharyngectomy, mandibulectomy, flap reconstruction, neck dissection, and Black race were associated with an increased length of stay and hospital-related costs. After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high-volume hospital and length of hospitalization and hospital-related costs.
After controlling for other factors, high-volume hospital care is associated with a shorter length of hospitalization and lower hospital-related cost of care for oropharyngeal cancer surgery. Laryngoscope, 2011