Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers

Jalisi, Scharukh; Rubin, Samuel J.; Wu, Kevin; Kirke, Diana N.

doi:10.1002/lary.26750

Cited by 10 publications

(12 citation statements)

References 29 publications

(63 reference statements)

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“…Our finding that higher surgical volume is associated with better survival outcomes in HNSCC is consistent with other studies in literature across a variety of conditions 10–12,28–30 . Higher case volume likely leads to more experience for the surgeons and greater exposure to both routine and difficult cases.…”

Section: Discussionsupporting

confidence: 90%

“…However, community medical centers were not included in the analysis of that study. Another study demonstrated that high‐volume academic centers had lower intensive care units stays but no differences in mortality in a geriatric population treated for head and neck cancer 11 . Further studies demonstrated that patients with nasopharyngeal carcinoma had better overall survival when treated at higher volume centers 12 .…”

Section: Introductionmentioning

confidence: 99%

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Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery

et al. 2020

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Objective To determine whether the academic affiliation or surgical volume affects the overall survival (OS) of human papillomavirus (HPV)–negative head and neck squamous cell carcinoma (HNSCC) patients receiving surgery. Methods A retrospective study of 39 North Carolina Medical Centers was conducted. Treatment centers were classified as academic hospitals, community cancer centers, or community hospitals and were divided into thirds by volume. The primary outcome was 5‐year OS. Hazard ratios (HR) were determined using Cox proportional hazard models, adjusting for demographics, tumor site, stage, insurance status, tobacco use, alcohol use, stage, chemotherapy, and radiation therapy. Patients were also stratified by stage (early stage and advanced stage). Results Patients treated at community cancer centers had significantly better 5‐year OS (HR 0.68, 95% confidence interval [CI] = 0.48–0.98), and patients treated at academic hospitals trended toward better 5‐year OS (HR 0.72, 95% CI = 0.50–1.04) compared to patients treated at community hospitals. The effect for academic affiliation on survival was more pronounced for patients with advanced stage cancer at diagnosis (HR 0.60, 95% CI = 0.37–0.95). There were no significant survival differences among early stage patients by treatment center type. Top‐third (HR = 0.64, 95% CI = 0.42–0.96) centers by surgical volume had significantly better 5‐year OS, and middle‐third (HR = 0.71, 95% CI = 0.51–1.03) centers by volume trended toward better 5‐year OS when compared to the bottom‐third centers by volume. Conclusion Patients treated at academic hospitals, community cancer centers, and hospitals in the top third by case volume have favorable survival for HPV‐negative HNSCC. The effect for academic hospitals is most pronounced among advanced stage patients. Level of Evidence 4 Laryngoscope, 131:E479–E488, 2021

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery

et al. 2020

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“…The overall 30-day postoperative mortality rate was 1.2%, which is similar to pre-COVID data. 30,31 Patients were more likely to develop severe pulmonary complications of COVID-19 if they had an advanced tumor stage or if they had been admitted to critical care. However, the absolute risks were approximately 3%, and this should Cancer Month 0, 2020 be considered from the perspective of the dismal prognosis for these patients if appropriate cancer treatment had been withheld.…”

Section: Discussionmentioning

confidence: 99%

Head and neck cancer surgery during the COVID‐19 pandemic: An international, multicenter, observational cohort study

Ho¹,

Omar²,

Jackson³

et al. 2020

Cancer

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BACKGROUND:The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. RESULTS: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. CONCLUSIONS: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Cancer 2020;0:1-13.

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“…Several studies in head and neck oncology have found that high-volume hospitals result in improved outcome metrics, such as shorter LOS and higher overall survival. 23,24 We propose that a similar underlying phenomenon occurs for JNA hospitalizations given that large sized hospitals are correlated with higher volume. This is further supported by the fact that patients at medium sized hospitals had a longer LOS by 1.24 days compared to large hospitals (P = .011).…”

Section: Discussionmentioning

confidence: 77%

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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Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers

Abstract: 2b. Laryngoscope, 127:2539-2544, 2017.

Cited by 10 publications

References 29 publications

Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery

Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery

Head and neck cancer surgery during the COVID‐19 pandemic: An international, multicenter, observational cohort study

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

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