Volume-Based Trends in Surgical Care of Patients with Oropharyngeal Cancer

Objective: Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal 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 oropharyngeal cancer surgical case volumes from 1990 to 2009. Results: Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P=.002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P<.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P<.001) and were more likely to perform partial glossectomy (OR = 1.8, P=.002), total glossectomy (OR = 3.8, P<.001), and neck dissection (OR = 2.3, P<.001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P<.001), partial glossectomy (OR = 1.4, P=.044), total glossectomy (OR = 4.3, P<.001), neck dissection (OR = 3.1, P<.001), flap reconstruction (OR = 1.9, P=.028), and prior radiation (OR = 5.0, P<.001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P<.001), increased mortality risk scores (OR = 3.1, P=.022), prior radiation (OR = 4.9, P=.011), and a decrease in partial glossectomy (OR = 0.5, P<.001), total glossectomy (OR = 0.4, P=.004), pharyngectomy (OR = 0.6, P=.007), and mandibulectomy (OR = 0.6, P=.022) procedures. Conclusions: The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.