Volume‐based trends in laryngeal cancer surgery

Abstract

Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of laryngeal cancer surgery by hospital and surgeon volume are poorly defined. The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon laryngeal cancer surgical case volumes from 1990 to 2009. Overall, 1,981 laryngeal cancer surgeries were performed by 288 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 19% in 1990 to 1999 to 35% in 2000 to 2009 (odds ratio [OR] = 3.0, P<.001), whereas cases performed at high-volume hospitals increased from 33% to 39% (OR = 2.0, P<.001). High-volume surgeons were more likely to perform total laryngectomy (OR = 1.7, P = .001) and neck dissection (OR = 1.7, P = .002). High-volume hospitals were significantly associated with total laryngectomy (OR = 2.0, P = .003), neck dissection (OR = 1.8, P = .038), flap reconstruction (OR = 5.1, P = .021), prior radiation (OR = 3.0, P = .031), and increased mortality risk scores (OR = 3.2, P = .006). After controlling for other variables, laryngeal cancer surgery in 2000 to 2009 was associated with increased access to high-volume surgeons (OR = 1.9, P<.001) and high-volume hospitals (OR = 1.3, P = .040), a decrease in partial and total laryngectomy procedures (OR = 0.2, P<.001), an increase in neck dissection (OR = 2.2, P< 0.001), an increase in prior radiation (OR = 3.0, P<.001), increased case complexity scores (OR = 5.7, P<.001), and an increase in wound fistula or dehiscence (OR = 2.0, P = .015) compared with 1990 to 1999. The proportion of laryngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly in 2000 to 2009 compared with 1990 to 1999, with a decrease in laryngectomy procedures and an increase in wound complications. These findings may be due to changing trends in primary management of laryngeal cancer.