Hospital Volume and Failure to Rescue in Head and Neck Cancer Surgery

Abstract

Objectives: (1) Apply the concept of failure to rescue to outcomes research in head and neck cancer (HNCA) surgery. (2) Understand the relationship between hospital volume and failure to rescue. Methods: Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 were analyzed using cross-tabulations and multivariate regression modeling. Failure to rescue was defined as death after a major complication including acute myocardial infarction, acute renal failure, venous thromboembolism, pneumonia, gastrointestinal bleed, pulmonary failure, hemorrhage, or surgical site infection. We compared the incidence of mortality, complications, and failure to rescue across hospital volume tertiles. Results: The majority of hospitals performing HNCA surgery were low-volume hospitals (N = 7635), which performed an average of 6 cases per year. Intermediate-volume hospitals (N = 729) performed a mean of 37 cases per year, and high-volume hospitals (N = 207) performed a mean of 131 cases per year. High-volume hospitals were associated with significantly decreased odds of death (0.7% vs 1.0%, odds ratio [OR] 0.56 [0.46-0.86]) compared with low-volume hospitals. There was no significant difference in major complication rates at high-volume hospitals compared with low-volume hospitals (18.5% vs 15.6%, OR 0.96 [0.80-1.15]); however, high-volume hospitals were associated with significantly decreased failure to rescue rates (3.1% vs 4.4%, OR 0.56 [0.33-0.97]) compared with low-volume hospitals. Conclusions: Improved survival among patients undergoing HNCA surgery at high-volume hospitals appears to be associated with differences in the response to and management of complications, rather than differences in complication rates.