TY - JOUR
T1 - Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?
AU - Hatch, Jonathan L.
AU - Bauschard, Michael J.
AU - Nguyen, Shaun A.
AU - Lambert, Paul R.
AU - Meyer, Ted A.
AU - McRackan, Theodore R.
N1 - Funding Information:
Address correspondence and reprint requests to Theodore R. McRackan, M.D., Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425; E-mail: mcrackan@musc.edu J.L.H. and M.J.B. contributed equally to this work. This publication was supported by a K12 award through the South Carolina Clinical and Translational Research Institute, with an academic home at the Medical University of South Carolina, NIH/NCATS Grant Number UL1TR001450 and a grant from the Doris Duke Foundation. The authors disclose no conflicts of interest.
Publisher Copyright:
© 2018, Otology Neurotology, Inc.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objective:To determine the effect of hospital surgical case volume on the outcomes of vestibular schwannoma surgery.Study Design:Retrospective case review.Setting:University HealthSystem Consortium member hospitals (includes nearly every US academic medical center).Patients:Three thousand six hundred ninety-seven patients who underwent vestibular schwannoma resection over a 3-year timespan (2012-2015) grouped by race, age, comorbidities, payer, and sex.Intervention:Surgical resection of vestibular schwannoma.Main Outcome Measures:Morbidity and mortality following vestibular schwannoma excision are compared by hospital volume (low, medium, and high) including deciles.Results:There was significantly longer length of stay (p ≤ 0.005) among groups with low-volume hospitals followed by medium-volume hospitals and high-volume hospitals. Low-volume hospitals had a significantly higher rate of complications including stroke, aspiration, and respiratory failure (p ≤ 0.0175). Patient characteristics of age, sex, sex, and baseline comorbidities were similar between hospital groups. However, patients at high-volume hospitals were more likely to be Caucasian (83.1%, p = 0.0001) and have private insurance (76.7%, p < 0.0001). There was a strong negative correlation between complication rates and hospital volume (r =-0.8164, p = 0.0040).Conclusion:The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.
AB - Objective:To determine the effect of hospital surgical case volume on the outcomes of vestibular schwannoma surgery.Study Design:Retrospective case review.Setting:University HealthSystem Consortium member hospitals (includes nearly every US academic medical center).Patients:Three thousand six hundred ninety-seven patients who underwent vestibular schwannoma resection over a 3-year timespan (2012-2015) grouped by race, age, comorbidities, payer, and sex.Intervention:Surgical resection of vestibular schwannoma.Main Outcome Measures:Morbidity and mortality following vestibular schwannoma excision are compared by hospital volume (low, medium, and high) including deciles.Results:There was significantly longer length of stay (p ≤ 0.005) among groups with low-volume hospitals followed by medium-volume hospitals and high-volume hospitals. Low-volume hospitals had a significantly higher rate of complications including stroke, aspiration, and respiratory failure (p ≤ 0.0175). Patient characteristics of age, sex, sex, and baseline comorbidities were similar between hospital groups. However, patients at high-volume hospitals were more likely to be Caucasian (83.1%, p = 0.0001) and have private insurance (76.7%, p < 0.0001). There was a strong negative correlation between complication rates and hospital volume (r =-0.8164, p = 0.0040).Conclusion:The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.
KW - Acoustic neuroma
KW - Clinical effectiveness research
KW - Clinical outcomes
KW - Database research
KW - Surgical volume
KW - Vestibular schwannoma
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U2 - 10.1097/MAO.0000000000001718
DO - 10.1097/MAO.0000000000001718
M3 - Article
C2 - 29342051
AN - SCOPUS:85044138723
VL - 39
SP - 481
EP - 487
JO - American Journal of Otology
JF - American Journal of Otology
SN - 1531-7129
IS - 4
ER -