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Volume‐based trends in surgical care of patients with oropharyngeal cancer
Author(s) -
Gourin Christine G.,
Forastiere Arlene A.,
Sanguineti Giuseppe,
Marur Shanthi,
Koch Wayne M.,
Bristow Robert E.
Publication year - 2011
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21457
Subject(s) - medicine , neck dissection , cancer , surgery , glossectomy , cancer surgery , tonsillectomy , odds ratio , dissection (medical) , head and neck cancer , radiation therapy , general surgery , tongue , pathology
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. Laryngoscope, 2011