Impact of Hospital Volume on Outcomes Following Head and Neck Cancer Surgery and Flap Reconstruction

Josef Madrigal; Laith Mukdad; Albert Y Han; Zachary Tran; Peyman Benharash; Maie A St John; Keith E Blackwell

doi:10.1002/lary.29903

Impact of Hospital Volume on Outcomes Following Head and Neck Cancer Surgery and Flap Reconstruction

Laryngoscope. 2022 Jul;132(7):1381-1387. doi: 10.1002/lary.29903. Epub 2021 Oct 12.

Authors

Josef Madrigal^{1

2}, Laith Mukdad¹, Albert Y Han¹, Zachary Tran², Peyman Benharash², Maie A St John¹, Keith E Blackwell¹

Affiliations

¹ Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.
² Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.

PMID: 34636433
DOI: 10.1002/lary.29903

Abstract

Objective/hypothesis: Utilization of flaps for reconstruction of large head and neck cancer (HNCA) defects has become more prevalent. The present study aimed to assess the impact of center experience as measured by annual hospital caseload on mortality, major complications, resource utilization, and 90-day readmissions following HNCA resection with flap reconstruction.

Study design: Non-Randomized Controlled Cohort Study.

Methods: All adult patients undergoing elective HNCA resection with flap reconstruction were identified utilizing the 2010 to 2018 Nationwide Readmissions Database. Hospitals were subsequently classified as low-, medium-, or high-volume based on annual institutional surgical caseload tertiles. Multivariable regression models were implemented to assess the independent association of hospital volume with the outcomes of interest.

Results: Over the nine-year study period, the proportion of HNCA resection with flap reconstruction gradually increased (12.8% in 2010 vs. 17.3% in 2018, P < .001). Although increasing hospital volume did not alter the odds of mortality, patients treated at high-volume centers were less likely to experience both surgical (adjusted odds ratio [AOR] 0.81, 95% confidence interval [CI] 0.67-0.97, P = .025) and medical complications (AOR 0.70, 95% CI 0.57-0.85, P < .001). Furthermore, these patients had shorter hospitalizations (-2.1 days, 95% CI -2.7 to -1.4 days, P < .001) and decreased costs (-$8,100, 95% CI -11,400 to -4,700, P < .001) compared to counterparts at low-volume centers. However, hospital volume did not impact 90-day readmissions.

Conclusion: Patients undergoing HNCA resection with flap reconstruction at high-volume centers were less likely to experience surgical and medical complications while incurring shorter hospitalizations and lower costs. Implementation of volume standards may be appropriate to improve outcomes in this surgical population.

Level of evidence: 3 Laryngoscope, 132:1381-1387, 2022.

Keywords: Head and neck; clinical research; reconstructive surgery.

Publication types

Controlled Clinical Trial

MeSH terms

Adult
Cohort Studies
Free Tissue Flaps* / surgery
Head and Neck Neoplasms* / surgery
Hospitals
Humans
Plastic Surgery Procedures* / adverse effects
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Surgical Flaps / surgery