Objectives: Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of laryngeal cancer surgery by hospital and surgeon volume are poorly defined.
Methods: The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon laryngeal cancer surgical case volumes from 1990 to 2009.
Results: Overall, 1,981 laryngeal cancer surgeries were performed by 288 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 19% in 1990 to 1999 to 35% in 2000 to 2009 (odds ratio [OR] ¼ 3.0, P < .001), whereas cases performed at high-volume hospitals increased from 33% to 39% (OR ¼ 2.0, P < .001). High-volume surgeons were more likely to perform total laryngectomy (OR ¼ 1.7, P ¼ .001) and neck dissection (OR ¼ 1.7, P ¼ .002). High-volume hospitals were significantly associated with total laryngectomy (OR ¼ 2.0, P ¼ .003), neck dissection (OR ¼ 1.8, P ¼ .038), flap reconstruction (OR ¼ 5.1, P ¼ .021), prior radiation (OR ¼ 3.0, P ¼ .031), and increased mortality risk scores (OR ¼ 3.2, P ¼ .006). After controlling for other variables, laryngeal cancer surgery in 2000 to 2009 was associated with increased access to high-volume surgeons (OR ¼ 1.9, P < .001) and high-volume hospitals (OR ¼ 1.3, P ¼ .040), a decrease in partial and total laryngectomy procedures (OR ¼ 0.2, P < .001), an increase in neck dissection (OR ¼ 2.2, P < 0.001), an increase in prior radiation (OR ¼ 3.0, P < .001), increased case complexity scores (OR ¼ 5.7, P < .001), and an increase in wound fistula or dehiscence (OR ¼ 2.0, P ¼ .015) compared with 1990 to 1999.
Conclusions: The proportion of laryngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly in 2000 to 2009 compared with 1990 to 1999, with a decrease in laryngectomy procedures and an increase in wound complications. These findings may be due to changing trends in primary management of laryngeal cancer.