“…According to previous studies and the literature, the reasons for suboptimal outcomes in certain hospital settings are likely to be multifactorial and include differences in staffing levels and skills [27][28][29][30][31] ; in resources, services, infrastructure, technologies, and available equipment 23,[30][31][32] ; in experience driven by the patient volume 30,33 ; in compliance with treatment guidelines 34 ; and in postoperative complication management. 23,32 In contrast to our findings of significant differences between urban teaching, nonteaching, and rural hospitals by insurance status, Bhattacharyya et al 31 analyzed data from the NIS and did not find any significant difference in the distribution of HNC patients by insurance status (payer mix) in teaching hospitals versus nonteaching hospitals in 2010. These differences might be the result of the different categorization of a hospital's teaching status in this study.…”