Outcomes in head and neck oncologic surgery at academic medical centers in the United States.

OBJECTIVES/HYPOTHESIS: To evaluate the impact of case volume and other variables on outcomes after head and neck oncologic surgery was performed at academic medical centers in the United States.

STUDY DESIGN: Cross Sectional Ecological Study.

METHODS: The University HealthSystems Consortium (UHC) database was analyzed for discharge data on all patients who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full- member academic medical centers between quarter 4 of 2006 and quarter 4 of 2009. Multivariate and linear regression analyses and chi-square tests were applied to evaluate significant associations between hospital surgical volume and other independent variables, and to evaluate the risk of mortality, mortality index, complications, length of stay (LOS), LOS index, cost, and cost index.

RESULTS: Of 22,357 surgical cases, 11,573 met our inclusion criteria. The only outcome that was statistically significant based on volume was a lower complication rate in high volume hospitals (P = 0.0486) as compared to low volume hospitals. All Payer Refined-Diagnosis Related Group defined major severity of illness was the only independent variable significantly associated with higher complication rates, observed LOS, and observed cost (P <0.0001, P = 0.0139, and P = 0.0092, respectively). Management of male patients and black patients resulted in a lower cost index (P = 0.0472) and a higher complication rate (P = 0.0297), respectively. Patients with private insurance had lower complication rates, observed LOS, and observed cost (P = 0.0401, P = 0.0001, and P = 0.0187, respectively).

CONCLUSIONS: After controlling for other factors, academic medical centers with a higher cumulative case volume have lower rates of complications.