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

Objectives/Hypothesis: The past 2 decades have witnessed an increase in the use of chemoradiation in the treatment of oropharyngeal cancer. We sought to characterize contemporary patterns of oropharyngeal cancer surgical care and the effect of volume on surgical care and short-term outcomes. Study Design: Retrospective cross-sectional study. Methods: Using the Nationwide Inpatient Sample database, temporal trends in oropharyngeal cancer surgical care were evaluated in 75,828 cases performed from 1993 through 2008, and relationships between volume and mortality, complications, length of stay, and costs were evaluated in 29,030 cases performed from 2003 through 2008 using regression analysis, adjusting for patient and provider characteristics. Results: Oropharyngeal cancer surgery from 2001 through 2008 was associated with increased use of high-volume hospitals (odds ratio [OR], 2.2; P =.016); an increase in tonsil (OR, 1.4; P <.001) and tongue base (OR, 1.3; P =.001) tumors; an increase in patients aged 40 to 64 years (OR, 1.5; P <.001); a decrease in partial glossectomy (OR, 0.8; P <.001), pharyngectomy (OR, 0.8; P =.003), mandibulectomy (OR, 0.6; P <.001) and laryngectomy procedures (OR, 0.6; P <.001); and an increase in prior radiation (OR, 1.7; P =.026), advanced comorbidity (OR, 1.4; P =.007), and wound complications (OR, 1.5; P =.029), compared to 1993 through 2000. High-volume hospitals were significantly associated with pharyngectomy (OR, 2.6; P =.001), while high-volume surgeons were associated with flap reconstruction (OR, 1.6; P =.005) and prior radiation (OR, 2.6; P =.013). After controlling for all other variables, a statistically significant interaction was observed between high-volume surgeons and high-volume hospitals, with reduced hospital-related costs for surgery performed by high-volume surgeons at high-volume hospitals. Conclusions: These data reflect changing trends in the epidemiology and primary management of oropharyngeal cancer, with meaningful differences in the type of surgical care provided by high-volume providers.