Hospital volume and failure to rescue after vestibular schwannoma resection

Background: Complication rates in many complex surgical procedures are associated with the volume of procedures performed. Objectives: To investigate the relationship between hospital volume and complications, mortality, and failure to rescue (FTR) rates in patients undergoing vestibular schwannoma (VS) surgery. Design, Setting, and Participants: The Nationwide Inpatient Sample was used to identify 44,336 patients who underwent VS surgery in 1995–2011. Annual case volumes were stratified by quintiles and defined as very low (≤5 cases/year), low (6–12 cases/year) medium (13–22 cases/year), high (23–37 cases/year), and very high-volume (≥38 cases/year). Main Outcomes and Measures: Relationships between hospital volume and in-hospital mortality, postoperative complications, as well as FTR rates, defined as death after a major complication, were examined using multivariate regression analysis. Results: Postoperative medical and surgical complications occurred in 5.4% and 14.6% of cases, respectively, and did not differ significantly across volume quintiles. In-hospital mortality decreased with increasing hospital volume, with an incidence of 1.4% for hospitals in the lowest volume quintile compared to 0.1% for hospitals in the top volume quintile. After controlling for all other variables, the odds of in-hospital mortality were lower for medium (OR = 0.19 [0.04–0.93]) and very high-volume hospitals (OR = 0.07 [0.01–0.53]), but not high-volume hospitals (OR = 0.43 [0.05–3.77]). There was no association between hospital volume and the odds of postoperative surgical complications. FTR was associated with hospital volume, with decreasing odds for medium-volume (OR = 0.15 [0.02–0.93]), high-volume (OR = 0.17 [0.04–0.74]), and very high-volume (OR = 0.07 [0.04–0.74]) hospitals. Conclusions: Hospital volume does not appear to be associated with complication rates but is associated with decreased likelihood of FTR after VS surgery. Level of Evidence: NA. Laryngoscope, 130:1287–1293, 2020.