HealthDay News — Laryngectomy outcomes appear to be associated with hospital volume for such cases, according to a study published online Nov. 21 in JAMA Otolaryngology-Head & Neck Surgery.
Christine G. Gourin, MD, from Johns Hopkins University in Baltimore, and colleagues evaluated the volume-outcome association for laryngectomy surgery to identify a minimum hospital volume threshold associated with improved outcomes. Data from the Nationwide Inpatient Sample was used to identify 45,156 patients who underwent laryngectomy procedures for a malignant laryngeal or hypopharyngeal neoplasm between 2001 and 2011.
The researchers found that higher-volume hospitals were more likely to be teaching hospitals in urban locations and to treat patients who had hypopharyngeal cancer. Higher-volume hospitals were more likely to treat patients of white race/ethnicity, who were admitted electively, who had no comorbidity, and who had private insurance. Further, higher-volume hospitals were more likely to perform flap reconstruction or concurrent neck dissection. In adjusted analysis, hospitals treating more than 6 cases per year were associated with lower odds of surgical and medical complications. The reduction in the odds of complications was greater with increasing hospital volume. Hospitals in the top-volume quintile (>28 cases per year) were associated with decreased odds of in-hospital mortality (odds ratio, 0.45), postoperative surgical complications (odds ratio, 0.63), and acute medical complications (odds ratio, 0.63). A statistically meaningful negative association was observed between the care at very high-volume hospitals and the mean incremental length of hospitalization (−3.7 days) and hospital-related costs (−$4,777).
“These data support the concept of centralization of complex care at centers able to meet minimum volume thresholds to improve patient outcomes,” the authors write.