Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer

Cheung, Michael C.; Koniaris, Leonidas G.; Pérez, Eduardo A.; Molina, Manuel A.; Goodwin, WillardE.; Salloum, Rabih M.

doi:10.1245/s10434-008-0191-9

Cited by 88 publications

(111 citation statements)

References 36 publications

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“…However, reports from the area of head and neck cancer are rare [28][29][30]. In the present study, surgery was performed in university centres or regional hospitals and there was some indication that survival was higher in patients from university centres than from other hospitals.…”

Section: Discussionmentioning

confidence: 73%

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Pála

Odrážka²,

Holečková³

et al. 2012

neo

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The objective of this study was to evaluate the feasibility, toxicity and efficacy of postoperative radiochemotherapy with weekly cisplatin in locoregionally advanced or high risk head and neck cancer in a single institutional setting.Patients with head and neck cancer of stage III/IV or patients with insufficient margins of resection were included in the study. Radiotherapy consisted of 70 Gy/ 7 weeks/ 35 fraction after R1/2 resection and 60-64 Gy/ 6-6,5 weeks/ 30-32 fraction after R0 resection, respectively. All patients received concurrent cisplatin 40 mg/m 2 weekly. Between 7/2002 and 12/2008, 100 consecutive patients [WHO ≤ 2, male to female ratio 84/16, median age 54 years] were treated. Tumors of the oropharynx were the most frequent (49%) and stage IV was predominant (86%). 96% patients received the full radiation treatment as planned, median total tumor dose was 66 Gy. Omission of weekly cisplatin had been occurring frequently, the most frequent reason for its early cessation were hematological toxicities (34%). Grade 3/4 mucosal toxicity developed in 32%. No death was observed during the treatment. The late toxicities were acceptable, predominantly subcutaneous fibrosis and xerostomia in most of the cases. We recorded six cases of osteonecrosis. Two and half year overall survival, locoregional control, time to progression and disease free survival were 64%, 88%, 79% and 59%, respectively.Postoperative radiochemotherapy with weekly cisplatin is toxic, but tolerable and highly effective in terms of locoregional control and survival. Multivariete analysis revealed that the only prognostic factor for survival was primary surgery at the University centre.

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Section: Discussionmentioning

confidence: 73%

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Pála

Odrážka²,

Holečková³

et al. 2012

neo

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show abstract

“…[21][22][23][24][25][26] In a study of 10 diverse procedures representing several surgical subspecialties with mortality rates greater than 1% previously demonstrated to have volume-outcome benefit, Birkmeyer et al 21 estimated that a 5% to 25% reduction in mortality could be realized if these procedures were regionalized to higher volume centers. Discussion of MVCs relative to their volume counterparts is also warranted.…”

Section: Discussionmentioning

confidence: 99%

Trends in Demographics, Charges, and Outcomes of Patients Undergoing Excision of Sporadic Vestibular Schwannoma

Ahmed¹,

Mahboubi²,

Lahham³

et al. 2013

Otolaryngol.--head neck surg.

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Objective. To assess demographics, charges, and outcome measures by temporal and volume analysis in the treatment of vestibular schwannoma.Design. Cross-sectional analysis.Setting, Subjects, and Methods. The California Hospital Inpatient Discharge Databases from 1996 to 2010.Results. A total of 6545 cases from 1996 to 2010 were identified. Of these, 86.2% occurred at high-volume centers (HVCs), and the number of annual cases decreased by 28.5% over the study period. Patients presenting for surgery were increasingly younger, non-Caucasian, and likely to have comorbidities. Total charges significantly increased over time (P \ .001), with the median total charge in 2006-2010 being $91,338 compared with $38,607.92 in 1996-2000 after adjusting for inflation. Routine discharges (home or residence) were more likely at HVCs (odds ratio [OR] 5.48, P \ .001) and less likely if patients had Medicaid (Medi-Cal; OR 0.51, P = .002) or Medicare (OR 0.55, P = .022), were 65 years or older (OR 0.56, P = .025), or had comorbidities (OR 0.54, P \ .001). Shorter hospital stays were more likely at HVCs (OR 3.77, P \ .001) and less likely if patients had Medicaid (OR 0.36, P \ .001) or comorbidities (OR 0.61, P \ .001). Lesser total charges were more likely at HVCs (OR 2.12, P = .002) and less likely if patients had comorbidities (OR 0.70, P \ .001). Mortality was less likely at HVCs (OR 0.10, P = .011).Conclusion. The profile of patients undergoing vestibular neuroma excision is changing. Surgical volume is decreasing, suggesting a trend toward more conservative management or stereotactic radiation. Patients are best served at HVCs, where routine discharges, shorter length of stay, decreased mortality, and lower total charges are more likely.

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“…13,19,36,41,45 This relationship is most profound in patients undergoing procedures that are not commonly performed. 38 Studies investi- ) performed at HVCs.…”

Section: Discussionmentioning

confidence: 99%

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Kalakoti

Missios

Menger

et al. 2015

FOC

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OBJECT Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database. METHODS Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period. RESULTS Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (> 75th percentile) (20.0%), high-end hospital charges (> 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16−0.98), unfavorable discharge (OR 0.86; 95% CI 0.76−0.98), prolonged length of stay (OR 0.69; 95% CI 0.62−0.77), high-end hospital charges (OR 0.67; 95% CI 0.60−0.74), neurological complications (OR 0.34; 95% CI 0.26−0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45−0.94), wound complications (OR 0.59; 95% CI 0.41−0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46−0.92). CONCLUSIONS The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.

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Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer

Cited by 88 publications

References 36 publications

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Trends in Demographics, Charges, and Outcomes of Patients Undergoing Excision of Sporadic Vestibular Schwannoma

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

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