Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?

Hatch, Jonathan L.; Bauschard, Michael J.; Nguyen, Shaun A.; Lambert, Paul R.; Meyer, Ted A.; McRackan, Theodore R.

doi:10.1097/mao.0000000000001718

Cited by 20 publications

(22 citation statements)

References 34 publications

(32 reference statements)

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“…Within otolaryngology, surgical procedures performed at high-volume centres have been shown to be associated with decreased mortality and fewer post-operative complications. 33, 34 Although collinearity between high parotidectomy case volume and teaching hospital status has not been directly studied, nor is that data available in the National Surgical Quality Improvement Program database, collinearity between these variables has been demonstrated in head and neck cancer surgery. 35 Further study is required to assess if parotidectomy case volume at institutions with resident involvement might explain the lower readmission, and reoperation rates associated with resident involvement.…”

Section: Discussionmentioning

confidence: 99%

Evaluating resident involvement and the ‘July effect’ in parotidectomy

et al. 2021

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Objective This study aimed to evaluate the effect of resident involvement and the ‘July effect’ on peri-operative complications after parotidectomy. Method The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. Results There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05–0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11–0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. Conclusion Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.

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Section: Discussionmentioning

confidence: 99%

Evaluating resident involvement and the ‘July effect’ in parotidectomy

et al. 2021

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“…26 This regionalization of care has led to high-volume centers, which have been associated with improved surgical outcomes. 27,28 Nevertheless, an adverse effect has been that the population groups in greatest need of specialized care at these high-volume centers have been shown to be the least likely to obtain the necessary optimal care. 4…”

Section: Discussionmentioning

confidence: 99%

Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

Hur

Gibbons

Finch

2020

Otolaryngol.--head neck surg.

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Objective To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists. Study Design Retrospective cross-sectional analysis. Setting United States. Subject and Methods Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics. Results There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county’s disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space. Conclusions There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.

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“…8,9 High-volume hospitals have been linked to shorter length of stay (LOS), reduced costs, and improved mortality. 10,11 Geographic location of a hospital has also been found to play a role in disease incidence, survival, and cost. [12][13][14] These studies together indicate that outcomes and total overall cost of care for head and neck tumors may not only be dependent on patient comorbidity but also on hospital-related characteristics.…”

Section: Introductionmentioning

confidence: 99%

Juvenile Nasopharyngeal Angiofibroma Outcomes and Cost: Analysis of the Kids’ Inpatient Database

Choi

Giannoni

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: To report trends in Juvenile Nasopharyngeal Angiofibroma (JNA) hospitalizations and identify key factors affecting treatment outcomes and cost of care in JNA patients. Methods: The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database was queried for all cases of JNA between the years of 1997 and 2016. Key factors extracted were patient demographics, geographic region, hospital size, teaching status, elective admissions, and number of diagnoses and procedures performed during the hospitalization. These elements were correlated to length of stay (LOS) and cost-per-day (CPD) using a multiple linear regression (MLR). Regional variation in JNA diagnosis and changes in LOS and CPD trends over time were also analyzed. Results: A total of 614 JNA patients were hospitalized in this time period, with a majority of patients identifying as male (98%) and Caucasian/White (55%). The average LOS has decreased by 0.14 day per year since 1997 ( P = .0034) whereas the CPD has steadily increased by $2 380 per year ( P < .001). MLR analysis revealed that while holding all other factors constant, patients who stayed at teaching hospitals had an increased LOS of 1.7 days ( P = .026), but paid $11 961 less per day ( P = .05). Regional variation in CPD was found in the Northeast region, where hospitalizations were more expensive by $9 801 per day compared to the South ( P = .017). Conclusion: These results indicate hospital characteristics, such as teaching status and geographic region, may predict differences in JNA outcomes and cost. Healthcare providers should be cognizant of these variations to ensure optimal patient outcomes and expenditures.

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Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?

Abstract: The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.

Cited by 20 publications

References 34 publications

Evaluating resident involvement and the ‘July effect’ in parotidectomy

Evaluating resident involvement and the ‘July effect’ in parotidectomy

Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

Juvenile Nasopharyngeal Angiofibroma Outcomes and Cost: Analysis of the Kids’ Inpatient Database

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