Changing Trends in Laryngeal Cancer and High-Volume Providers

What are the contemporary patterns of laryngeal cancer surgical care and the effect of volume status on surgical care and short-term outcomes?

Background: Because there is a positive relationship between surgical volume and outcomes, as well as surgeon-based care, these observations have served as the basis for the adoption of hospital volume standards as a surrogate marker for quality. The authors note that this relationship may be important for laryngeal cancer, which has undergone a treatment paradigm shift in the past two decades.

Study design: Retrospective cross-sectional study.

Setting: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine; Department of Health and Public Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Synopsis: The authors used the Nationwide Inpatient Sample database to look at trends in laryngeal cancer surgical care in 78,478 cases performed during the years of 1993 through 2008. Relationships between volume and mortality, complications, length of stay and costs were evaluated in 24,856 cases performed from 2003 through 2008.

The incidence of laryngeal cancer has decreased in the past 20 years, primarily because of decreased tobacco use, but there has been an even greater decrease in the use of primary surgical management, with a corresponding increase in the use of chemoradiation.

Patients treated by surgeons and hospitals in the top volume quintile were more likely to undergo more sophisticated operations such as partial laryngectomy and flap reconstruction.

These surgeons were more likely to treat patients who had undergone prior radiation and less likely to operate on patients with advanced comorbidity. Procedures performed by surgeons in the top-volume quintile were associated with a greater reduction in hospital stay and lower hospital-related costs.

The authors suggest that high-volume surgeons take the initiative in defining the processes of care that define quality and impact incomes, an action that would benefit community hospitals. A limitation to their study was the use of hospital discharge data that provided no follow-up.

Bottom line: There are meaningful differences in the type of surgical care provided by high-volume providers, including an increase in prior radiation and reduced hospital-related costs.

Reference: Gourin CG, Frick KD. National trends in laryngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care. Laryngoscope. 2012;122(1):88-94.