TY - JOUR
T1 - Volume-based trends in surgical care of patients with oropharyngeal cancer
AU - Gourin, Christine G.
AU - Forastiere, Arlene A.
AU - Sanguineti, Giuseppe
AU - Marur, Shanthi
AU - Koch, Wayne M.
AU - Bristow, Robert E.
PY - 2011/4
Y1 - 2011/4
N2 - Objective: Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined. Methods: The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009. Results: Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P =.002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P <.001) and were more likely to perform partial glossectomy (OR = 1.8, P =.002), total glossectomy (OR = 3.8, P <.001), and neck dissection (OR = 2.3, P <.001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P <.001), partial glossectomy (OR = 1.4, P =.044), total glossectomy (OR = 4.3, P <.001), neck dissection (OR = 3.1, P <.001), flap reconstruction (OR = 1.9, P =.028), and prior radiation (OR = 5.0, P <.001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P <.001), increased mortality risk scores (OR = 3.1, P =.022), prior radiation (OR = 4.9, P =.011), and a decrease in partial glossectomy (OR = 0.5, P <.001), total glossectomy (OR = 0.4, P =.004), pharyngectomy (OR = 0.6, P =.007), and mandibulectomy (OR = 0.6, P =.022) procedures. Conclusions: The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.
AB - Objective: Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined. Methods: The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009. Results: Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P =.002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P <.001) and were more likely to perform partial glossectomy (OR = 1.8, P =.002), total glossectomy (OR = 3.8, P <.001), and neck dissection (OR = 2.3, P <.001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P <.001), partial glossectomy (OR = 1.4, P =.044), total glossectomy (OR = 4.3, P <.001), neck dissection (OR = 3.1, P <.001), flap reconstruction (OR = 1.9, P =.028), and prior radiation (OR = 5.0, P <.001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P <.001), increased mortality risk scores (OR = 3.1, P =.022), prior radiation (OR = 4.9, P =.011), and a decrease in partial glossectomy (OR = 0.5, P <.001), total glossectomy (OR = 0.4, P =.004), pharyngectomy (OR = 0.6, P =.007), and mandibulectomy (OR = 0.6, P =.022) procedures. Conclusions: The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.
KW - Volume
KW - oropharyngeal neoplasms
KW - squamous cell cancer
KW - surgery.
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U2 - 10.1002/lary.21457
DO - 10.1002/lary.21457
M3 - Article
C2 - 21394725
AN - SCOPUS:79953114370
SN - 0023-852X
VL - 121
SP - 738
EP - 745
JO - Laryngoscope
JF - Laryngoscope
IS - 4
ER -