Saraswathula from
Johns Hopkins University in Baltimore, and colleagues evaluated therelationship between surgeon volume and operative morbidity and mortality for
laryngectomy.
The Nationwide Inpatient Sample was used to identify 45,156
patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal
cancer between 2001 and 2011.
The authors found that higher-volume surgeons were more
likely to operate at large, teaching, nonprofit hospitals and were more likely
to treat patients who were white, had private insurance, hypopharyngeal cancer,
low comorbidity, admitted electively, and to perform partial laryngectomy,
concurrent neck dissection, and flap reconstruction. Surgeons treating more
than 5 cases per year were associated with lower odds of medical and surgical
complications, with a greater reduction in the odds of complications with
increasing surgical volume. Surgeons in the top volume quintile (>9
cases/year) were associated with a decreased odds of in-hospital mortality (OR
= 0.09 [0.01-0.74]), postoperative surgical complications (OR = 0.58
[0.45-0.74]), and acute medical complications (OR = 0.49 [0.37-0.64]). Surgeon
volume accounted for 95% of the effect of hospital volume on mortality and
16%-47% of the effect of hospital volume on postoperative morbidity.
The authors concluded that there is a strong volume-outcome
relationship for laryngectomy, with reduced mortality and morbidity associated
with higher surgeon and higher hospital volumes. Observed associations between
hospital volume and operative morbidity and mortality are mediated by surgeon
volume, suggesting that surgeon volume is an important component of the
favorable outcomes of high-volume hospital care.
