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Volume-based trends in surgical care of patients with oropharyngeal cancer

Authors

  • Christine G. Gourin MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
    • Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 N. Caroline Street, Suite 6260, Baltimore, MD 21287
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  • Arlene A. Forastiere MD,

    1. the Department of Oncology , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
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  • Giuseppe Sanguineti MD,

    1. the Sidney Kimmel Comprehensive Cancer Center, Department of Radiation Oncology and Molecular Radiation Sciences , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
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  • Shanthi Marur MD, MBBS,

    1. the Department of Oncology , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
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  • Wayne M. Koch MD,

    1. Department of Otolaryngology—Head and Neck Surgery , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
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  • Robert E. Bristow MD

    1. the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics , The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
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  • The authors have no financial disclosures for this article.

  • The authors have no conflicts of interest to disclose.

Abstract

Objective:

Positive volume–outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined.

Methods:

The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009.

Results:

Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P = .002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P < .001) and were more likely to perform partial glossectomy (OR = 1.8, P = .002), total glossectomy (OR = 3.8, P < .001), and neck dissection (OR = 2.3, P < .001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P < .001), partial glossectomy (OR = 1.4, P = .044), total glossectomy (OR = 4.3, P < .001), neck dissection (OR = 3.1, P < .001), flap reconstruction (OR = 1.9, P = .028), and prior radiation (OR = 5.0, P < .001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P < .001), increased mortality risk scores (OR = 3.1, P = .022), prior radiation (OR = 4.9, P = .011), and a decrease in partial glossectomy (OR = 0.5, P < .001), total glossectomy (OR = 0.4, P = .004), pharyngectomy (OR = 0.6, P = .007), and mandibulectomy (OR = 0.6, P = .022) procedures.

Conclusions:

The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer. Laryngoscope, 2011

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