Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Hatch, Jonathan L.; Bauschard, Michael J.; Nguyen, Shaun A.; Lambert, Paul R.; Meyer, Ted A.; McRackan, Theodore R.
• Is Part Of: Otology & neurotology. Volume 39:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: Acoustic neuroma -- Clinical effectiveness research -- Clinical outcomes -- Database research -- Surgical volume -- Vestibular schwannoma; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000001718
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : 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.