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Surgeon Volume and Laryngectomy Outcomes
Anirudh Saraswathula1, J Matthew Austin2,3, Carole Fakhry1
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
The Laryngoscope
|May 31, 2022
Summary
Higher surgeon volume in laryngectomy procedures is linked to significantly lower patient mortality and complication rates. Surgeon expertise, not just hospital size, is key to better outcomes in these complex surgeries.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Health Services Research
Background:
- Laryngectomy is a complex procedure for laryngeal and hypopharyngeal cancers.
- The relationship between surgeon expertise (volume) and patient outcomes is crucial but requires further investigation.
Purpose of the Study:
- To investigate the association between surgeon volume and operative morbidity and mortality in patients undergoing laryngectomy.
- To determine if surgeon volume mediates the effect of hospital volume on laryngectomy outcomes.
Main Methods:
- Analysis of 45,156 laryngectomy cases from the Nationwide Inpatient Sample (2001-2011).
- Multivariable regression models were used to assess relationships between hospital/surgeon volume and mortality/complications.
- Surgeon and hospital volumes were categorized for analysis.
Main Results:
- Higher-volume surgeons were associated with significantly lower odds of in-hospital mortality (OR=0.09), postoperative surgical complications (OR=0.58), and acute medical complications (OR=0.49).
- Surgeons performing >5 cases/year showed reduced complications, with greater benefits seen in the top quintile (>9 cases/year).
- Surgeon volume explained 95% of the hospital volume's effect on mortality and 16%-47% on morbidity.
Conclusions:
- A strong volume-outcome relationship exists for laryngectomy, with higher surgeon volume correlating to reduced mortality and morbidity.
- Surgeon volume is a critical factor mediating the positive outcomes observed in high-volume hospital care for laryngectomy patients.
