Laryngectomy: high hospital volume tied to fewer complications

  • Gourin CG & al.
  • JAMA Otolaryngol Head Neck Surg
  • 21 nov. 2018

  • Par Brian Richardson, PhD
  • Résumés d'articles
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Takeaway

  • A cross-sectional study of the Nationwide Inpatient Sample suggests that higher hospital volume is associated with fewer laryngectomy complications among patients with larynx cancer.

Why this matters

  • This study suggests that treatment outcomes are improved at larger, centralized centers.

Key results

  • Very high volume hospitals (>28 cases per year) were associated with reduced in-hospital mortality (OR, 0.45; 95% CI, 0.23-0.88), postoperative surgical complications (OR, 0.63; 95% CI, 0.50-0.79), and acute medical complications (OR, 0.63; 95% CI, 0.48-0.81) compared with very low volume hospitals (≤3 cases per year).
  • High-volume (16-28 cases per year) and medium-volume (7-15 cases per year) hospitals were also associated with reduced postoperative surgical complications (OR, 0.72 [95% CI, 0.58-0.88] and 0.81 [95% CI, 0.66-0.98], respectively) and acute medical complications (OR, 0.66 [95% CI, 0.52-0.84] and 0.74 [95% CI, 0.59-0.92], respectively).
  • High-volume and very high volume hospitals were associated with reduced length of hospitalization (mean, −2.6 and −3.7 days, respectively).
  • Very high volume hospitals were associated with reduced hospital-related costs (mean, −$4777).

Study design

  • 45,156 patients with larynx cancer from 5516 hospitals who received laryngectomy were analyzed for associations between hospital volume and outcomes.
  • Funding: None disclosed.

Limitations

  • Limited follow-up and long-term outcome analysis.