Objective To characterize contemporary patterns of thyroid surgical care and variables associated with access to high-volume care. Design Cross-sectional analysis. Setting Maryland Health Service Cost Review Commission database. Patients Adults who underwent surgery for thyroid disease in Maryland between January 1, 1990, and July 1, 2009. Results Overall, 21 270 thyroid surgical procedures were performed by 1034 surgeons at 51 hospitals. Procedures performed by high-volume surgeons increased from 15.7% in 1990-1999 to 30.9% in 2000-2009 (odds ratio [OR], 3.69; P P P P P P  = .002), hypocalcemia (0.62; P P  = .01). After controlling for other variables, thyroid surgery in 2000-2009 was associated with high-volume surgeons (OR, 1.76; P P P P  = .02) but was less likely to be performed for cancer (0.83; P Conclusions The proportion of thyroid surgical procedures performed by high-volume surgeons and in high-volume hospitals increased significantly from 1990-1999 to 2000-2009, with an increase in total thyroidectomy and neck dissection. Surgeon volume was significantly associated with complication rates. Thyroid cancer surgery was less likely to be performed by high-volume surgeons and in 2000-2009 despite an increase in surgical cases. Further investigation is needed to identify factors contributing to this trend.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/497091/ooa05094_1191_1198.pdf

Volume-Based Trends in Thyroid Surgery

Background

Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high- and low-volume centers have demonstrated mixed results.



Methods

We conducted a systematic review using MEDLINE and EMBASE including all studies examining a volume–outcome relationship in the treatment of patients with head and neck cancer with meta-analysis for long-term survival results.



Results

Seventeen studies were identified. Meta-analysis was performed for studies that assessed long-term survival. High-volume hospitals (5 studies; hazard ratio [HR], 0.886; 95% confidence interval [CI], 0.820–0.956) and high-volume surgeons (2 studies; HR, 0.767; 95% CI, 0.641–0.919) have better overall survival than low-volume hospitals and surgeons, respectively.



Conclusion

Volume–outcome associations exist for head and neck oncologic procedures, although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care, which may explain this relationship. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1820–1834, 2014

Volume-outcome associations in head and neck cancer treatment: a systematic review and meta-analysis.

ObjectiveTo describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment.Study DesignPopulation-based cohort studySettingHealthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges.Subjects and MethodsAll patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge.ResultsBetween 1997 and 2008, the number of laryngectomies done in the United States decreased by 48%. New cases of laryngeal cancer decreased 33% during the same time. The proportion of patients older than 65 years decreased from 48% to 43%. Mortality for the procedure was 1.4% in 1997 and 1.1% in 2008. Mean length of stay over the study period increased from 13 days to 14 days. Mean hospital charges rose from $58,000 in 1997 to $...

/pdf/trends-in-total-laryngectomy-in-the-era-of-organ-3p6gnsb83k.pdf

Trends in Total Laryngectomy in the Era of Organ Preservation: A Population-Based Study

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.

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

Background
Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear.

Methods
The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)start, RT duration, total treatment package (surgery-to-RTend), and diagnosis-to-RTend were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model.

Results
Medians for diagnosis-to-surgery, surgery-to-RTstart, RT duration, total treatment package, and diagnosis-to-RTend were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02).

Conclusion
Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck 39: 639–646, 2017

Treatment delays in oral cavity squamous cell carcinoma and association with survival.

The objective of this study was to define the prognostic significance of surgical center case volume on outcome for head and neck cancer (HNC). Florida cancer registry and inpatient hospital data were queried for HNC diagnosed from 1998 to 2002. Of the 11,160 operative cases of HNC identified, 35.3% were treated at low-volume centers (LVCs), 32.7% in intermediate-volume centers (IVC), and 32.1% at high-volume centers (HVC). A larger proportion of high-grade tumors (27.9%) and lesions over 30 mm (39.7%) were resected at HVC (p 30 mm), high-grade or parotid, larynx, and pharynx tumors should be evaluated and offered care at a high-volume center.

Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer

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Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer