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National trends in surgery for sinonasal malignancy and the effect of hospital volume on short‐term outcomes
Author(s) -
Ouyang David,
ElSayed Ivan H.,
Yom Sue S.
Publication year - 2014
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.24578
Subject(s) - medicine , malignancy , neck dissection , retrospective cohort study , surgery , cohort , dissection (medical) , mortality rate , base of skull , skull , cancer
Objectives/Hypothesis To characterize trends in the management of sinonasal malignancy with a focus on the impact of hospital volume on surgical outcomes. Study Design Retrospective cohort study. Methods Time trends were analyzed among patients admitted for surgical resection of sinonasal malignancy in the Nationwide Inpatient Sample (NIS) between 1988 and 2009. Subset analysis was performed on cohorts with skull base or orbital involvement or on cohorts who underwent neck dissection. Patient characteristics and hospital attributes were correlated with morbidity and mortality. Results Over 22 years, we identified 3,850 cases from 879 hospitals. A total of 24.3% of patients had complications and 0.8% of hospitalizations resulted in mortality. Cases with skull base or orbital involvement, or cases including neck dissection, had more complications and a longer length of stay. Prevalence of neck dissection increased over time. Thirty‐two hospitals averaged more than five cases per year, accounting for 28% of all surgeries. These centers were large (73.3%), urban (96.7%), teaching (90%) institutions and performed more high‐risk cases: 32.4% of neck dissections, 44.6% of orbital cases, and 43.1% of skull base cases. Compared to lower‐volume centers, these centers had more cardiopulmonary and electrolyte complications, but no difference was observed in the lengths of stay. A greater proportion of cases were recently performed at high‐volume centers. Conclusion Over time, complicated surgeries were more likely to occur at higher‐volume hospitals without significant changes in surgical complication rates. High‐volume centers had increased rates of cardiopulmonary and electrolyte complications, likely representing complex postoperative management, but these were not associated with higher mortality. Level of Evidence 2c. Laryngoscope , 124:1609–1614, 2014