National trends in laryngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care

Abstract

Objectives/hypothesis: The past 2 decades have witnessed an increase in the use of chemoradiation in the treatment of laryngeal cancer. We sought to characterize contemporary patterns of laryngeal cancer surgical care and the effect of volume status on surgical care and short-term outcomes.

Study design: Retrospective cross-sectional study.

Methods: Using the Nationwide Inpatient Sample database, temporal trends in laryngeal cancer surgical care were evaluated in 78,478 cases performed in 1993 to 2008. Relationships between volume and mortality, complications, length of stay, and costs were evaluated in 24,856 cases performed in 2003 to 2008 using regression analysis, with adjustment for patient and provider characteristics.

Results: Laryngeal cancer surgery in 2001 to 2008 was associated with increased utilization of high-volume hospitals (odds ratio [OR]=2.0, P=.039), a decrease in partial and total laryngectomy procedures (OR=0.7, P<.001), an increase in flap reconstruction (OR=1.6, P<.001), prior radiation (OR=2.2, P<.001), comorbidity (OR=1.6, P<.001), and wound complications (OR=4.0, P<.001), compared to 1993 to 2000. High-volume hospitals were significantly associated with partial laryngectomy (OR=1.8, P=.026) and flap reconstruction (OR=1.8, P=.027). High-volume surgeons were associated with partial laryngectomy (OR=1.7, P=.048), flap reconstruction (OR=1.6, P=.029), prior radiation (OR=2.2, P=.013), and comorbidity (OR=0.4, P=.008). After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high-volume hospital and length of hospitalization, and surgery by a high-volume surgeon was associated with even greater reductions in length of hospitalization as well as lower hospital-related costs.

Conclusions: These data reflect changing trends in the primary management of laryngeal cancer, with meaningful differences in the type of surgical care provided by high-volume providers.