Going the distance in acoustic neuroma resection: microsurgical outcomes at high-volume centers of excellence

Abstract

Purpose: High-volume hospitals are associated with improved surgical outcomes for acoustic neuromas (ANs). Due to the benign and slow-growing nature of ANs, many patients travel to geographically distant cities, states, or countries for their treatment. However, the impact of travel burden to high-volume centers, as well as its relative bene t are poorly understood. We compared post-operative outcomes between AN patients that underwent treatment at local, lowvolume hospitals with those that traveled long distances to high-volume hospitals.Methods: The National Cancer Database was used to analyze AN patients that underwent surgery (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Patients in the lowest quartile of travel distance and volume (Short-travel/Low-Volume: STLV) were compared to patients in the highest quartile of travel distance and volume (Long-travel/High-Volume: LTHV). Only STLV and LTHV cases were included for analysis.Results: Of 13,370 cases, 2,408 met inclusion criteria. STLV patients (n = 1,305) traveled a median of 6 miles (Interquartile range [IQR] 3-9) to low-volume centers (median 2, IQR 1-3 annual cases) and LTHV patients (n = 1,103) traveled a median of 143 miles maximum 4,797] to high-volume centers (median 34, IQR 28-42 annual cases). LTHV patients had lower Charlson/Deyo scores (p=0.001), mostly received care at academic centers (81.7% vs 39.4%, p<0.001), and were less likely to be minorities (7.0% vs 24.2%, p<0.001) or underinsured (4.2% vs 13.8%, p<0.001). There was no difference in average tumor size.On multivariable analysis, LTHV predicted increased likelihood of gross total resection (odds ratio [OR] 5.6, 95% con dence interval [CI] 3.8-8.4, p<0.001), longer duration between diagnosis and surgery (OR 1.3, 95% CI 1.0-1.6, p=0.040), decreased length of hospital stay (OR 0.5, 95% CI 0.4-0.7, p<0.001), and greater overall survival (Hazard Ratio [HR] 0.6, 95% CI 0.4-0.95, p=0.029). There was no signi cant difference in 30-day readmission on adjusted analysis. Conclusion: Although traveling farther to high-volume centers increased the time between diagnosis and treatment for AN patients, they experienced superior postoperative outcomes compared to patients who received treatment locally at low-volume centers. Enabling access and travel to high-volume centers may improve AN patient outcomes. decision-making. Therefore, patients diagnosed with ANs may have the choice to pursue treatment at a local, low-volume hospital versus traveling larger distances to reach a high-volume center. The objective of this study was to determine the impact of travel burden and hospital volume on post-operative outcomes of patients with ANs. Methods Patient PopulationThe National Cancer Database (NCDB) is a joint program of the Commission on Cancer and the American Cancer Society. Nearly 70% of new cancer cases among patients ≥ 18 years of age in the United States from over 1500 hospital clinics are included in the database. In our analysis, we included patients diagnosed with an aco...