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- Title
Association Between Facility Surgical Volume and Excess Time in the Hospital After Surgical Resection of Vestibular Schwannomas.
- Authors
Dixon, Peter R.; Moshtaghi, Omid; Khan, Usman; Harris, Jeffrey P.; Schwartz, Marc S.; Friedman, Rick A.
- Abstract
Key Points: Question: Is the number of surgical cases performed at a facility associated with excess time in the hospital after vestibular schwannoma resection? Findings: In this cohort study of 11 524 adult patients who underwent vestibular schwannoma resection at 66 reporting facilities, facility case volume was associated with lower adjusted risk of prolonged hospital stay or readmission within 30 days of surgery for vestibular schwannoma. When volume exceeded 25 cases per year, the declining risk of excess time in the hospital began to plateau. Meaning: These findings suggest that higher hospital surgical volume may be associated with reduced risk of excess time in the hospital after vestibular schwannoma surgery, and 25 cases per year may represent a risk-defining threshold. This cohort study uses national data to analyze the association between facility surgical case volume and length of hospital stay after vestibular schwannoma resection. Importance: High surgical vestibular schwannoma case volume in a medical institution may decrease the risk of adverse outcomes among patients undergoing vestibular schwannoma surgery. Objective: To study the association between surgical vestibular schwannoma case volume and excess time in the hospital after vestibular schwannoma surgery. Design, Setting, and Participants: This cohort study evaluated data from the National Cancer Database from January 1, 2004, through December 31, 2019, on Commission on Cancer–accredited facilities in the US. The hospital-based sample comprised adult patients aged 18 years or older with a vestibular schwannoma treated with surgery. Exposures: Facility case volume, defined as the mean number of surgical vestibular schwannoma cases per year in the 2 years preceding the index case. Main Outcomes and Measures: The primary outcome was a composite of prolonged hospital stay (>90th percentile) or 30-day readmission. Risk-adjusted restricted cubic splines were used to model the probability of the outcome according to facility volume. The inflection point (in cases per year) when the declining risk of excess time in the hospital began to plateau was selected as the threshold to define high- and low-volume facilities. Outcomes were compared among patients treated at high- and low-volume facilities, with mixed-effects logistic regression models adjusting for patient sociodemographic characteristics, comorbidities, tumor size, and clustering within facilities. Collected data were analyzed between June 24 and August 31, 2022. Results: Among 11 524 eligible patients (mean [SD] age, 50.2 [12.8] years; 53.5% female; 46.5% male) who underwent surgical resection of vestibular schwannoma at 66 reporting facilities, the median length of stay was 4 (IQR, 3-5) days, and 655 patients (5.7%) were readmitted within 30 days. The median case volume was 16 (IQR, 9-26) cases per year. An adjusted restricted cubic spline model identified a downtrending probability of excess time in the hospital with increasing volume. The declining risk of excess time in the hospital began to plateau at a facility volume of 25 cases per year. Surgery at a facility with an annual case volume at or above this threshold was independently associated with a 42% reduction in the odds of excess time in the hospital compared with surgery at a low-volume center (odds ratio, 0.58; 95% CI, 0.44-0.77). Conclusions and Relevance: This cohort study found that among adults undergoing vestibular schwannoma surgery, a higher facility case volume was associated with a reduced risk of prolonged hospital stay or 30-day readmission. A facility case volume of 25 cases per year may represent a risk-defining threshold.
- Publication
JAMA Otolaryngology-Head & Neck Surgery, 2023, Vol 149, Issue 4, p352
- ISSN
2168-6181
- Publication type
Article
- DOI
10.1001/jamaoto.2022.5243