The authors have no funding, financial relationships, or conflicts of interest to disclose.
Head and Neck
National trends in oropharyngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care†
Article first published online: 12 JAN 2012
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 3, pages 543–551, March 2012
How to Cite
Gourin, C. G. and Frick, K. D. (2012), National trends in oropharyngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care. The Laryngoscope, 122: 543–551. doi: 10.1002/lary.22447
- Issue published online: 21 FEB 2012
- Article first published online: 12 JAN 2012
- Accepted manuscript online: 7 NOV 2011 11:01AM EST
- Manuscript Accepted: 23 FEB 2011
- Manuscript Revised: 18 FEB 2011
- Manuscript Received: 3 FEB 2011
- oropharyngeal neoplasms;
- squamous cell cancer;
- Nationwide Inpatient Sample;
- Level of Evidence: 2c
The past 2 decades have witnessed an increase in the use of chemoradiation in the treatment of oropharyngeal cancer. We sought to characterize contemporary patterns of oropharyngeal cancer surgical care and the effect of volume on surgical care and short-term outcomes.
Retrospective cross-sectional study.
Using the Nationwide Inpatient Sample database, temporal trends in oropharyngeal cancer surgical care were evaluated in 75,828 cases performed from 1993 through 2008, and relationships between volume and mortality, complications, length of stay, and costs were evaluated in 29,030 cases performed from 2003 through 2008 using regression analysis, adjusting for patient and provider characteristics.
Oropharyngeal cancer surgery from 2001 through 2008 was associated with increased use of high-volume hospitals (odds ratio [OR], 2.2; P = .016); an increase in tonsil (OR, 1.4; P < .001) and tongue base (OR, 1.3; P = .001) tumors; an increase in patients aged 40 to 64 years (OR, 1.5; P < .001); a decrease in partial glossectomy (OR, 0.8; P < .001), pharyngectomy (OR, 0.8; P = .003), mandibulectomy (OR, 0.6; P < .001) and laryngectomy procedures (OR, 0.6; P < .001); and an increase in prior radiation (OR, 1.7; P = .026), advanced comorbidity (OR, 1.4; P = .007), and wound complications (OR, 1.5; P = .029), compared to 1993 through 2000. High-volume hospitals were significantly associated with pharyngectomy (OR, 2.6; P = .001), while high-volume surgeons were associated with flap reconstruction (OR, 1.6; P = .005) and prior radiation (OR, 2.6; P = .013). After controlling for all other variables, a statistically significant interaction was observed between high-volume surgeons and high-volume hospitals, with reduced hospital-related costs for surgery performed by high-volume surgeons at high-volume hospitals.
These data reflect changing trends in the epidemiology and primary management of oropharyngeal cancer, with meaningful differences in the type of surgical care provided by high-volume providers.