In:
The Laryngoscope, Wiley, Vol. 130, No. 5 ( 2020-05), p. 1287-1293
Abstract:
Complication rates in many complex surgical procedures are associated with the volume of procedures performed. Objectives To investigate the relationship between hospital volume and complications, mortality, and failure to rescue (FTR) rates in patients undergoing vestibular schwannoma (VS) surgery. Design, Setting, and Participants The Nationwide Inpatient Sample was used to identify 44,336 patients who underwent VS surgery in 1995–2011. Annual case volumes were stratified by quintiles and defined as very low (≤5 cases/year), low (6–12 cases/year) medium (13–22 cases/year), high (23–37 cases/year), and very high‐volume (≥38 cases/year). Main Outcomes and Measures Relationships between hospital volume and in‐hospital mortality, postoperative complications, as well as FTR rates, defined as death after a major complication, were examined using multivariate regression analysis. Results Postoperative medical and surgical complications occurred in 5.4% and 14.6% of cases, respectively, and did not differ significantly across volume quintiles. In‐hospital mortality decreased with increasing hospital volume, with an incidence of 1.4% for hospitals in the lowest volume quintile compared to 0.1% for hospitals in the top volume quintile. After controlling for all other variables, the odds of in‐hospital mortality were lower for medium (OR = 0.19 [0.04–0.93]) and very high‐volume hospitals (OR = 0.07 [0.01–0.53] ), but not high‐volume hospitals (OR = 0.43 [0.05–3.77]). There was no association between hospital volume and the odds of postoperative surgical complications. FTR was associated with hospital volume, with decreasing odds for medium‐volume (OR = 0.15 [0.02–0.93]), high‐volume (OR = 0.17 [0.04–0.74] ), and very high‐volume (OR = 0.07 [0.04–0.74]) hospitals. Conclusions Hospital volume does not appear to be associated with complication rates but is associated with decreased likelihood of FTR after VS surgery. Level of Evidence NA Laryngoscope , 130:1287–1293, 2020
Type of Medium:
Online Resource
ISSN:
0023-852X
,
1531-4995
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2026089-1
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