Vestibular schwannoma surgical volume and short-term outcomes in Maryland.
OBJECTIVE
To characterize contemporary practice patterns and outcomes of vestibular schwannoma surgery.


METHODS
Cross-sectional analysis.


METHODS
Maryland Health Service Cost Review Commission database.


METHODS
The study included patients who underwent surgery for vestibular schwannoma between 1990 and 2009.


METHODS
Temporal trends and relationships between volume and in-hospital deaths, central nervous system (CNS) complications, length of hospitalization, and costs.


RESULTS
A total of 1177 surgical procedures were performed by 57 surgeons at 12 hospitals. Most cases were performed by high-volume surgeons (47%) at high-volume hospitals (79%). The number of cases increased from 474 in 1999-2000 to 703 in 2000-2009. Vestibular schwannoma surgery in 2000-2009 was associated with a decrease in CNS complications (odds ratio [OR] 0.4; P < .001) and an increase in cases performed by intermediate-volume (OR, 4.2; P = .002) and high-volume (OR, 3.2; P = .005) hospitals and intermediate-volume (OR, 1.9; P = .004) and high-volume (OR, 1.8; P = .006) surgeons. High-volume care was inversely related to the odds of urgent and emergent surgery (OR, 0.2; P < .001) and readmissions (OR, 0.1; P = .02). Surgeon volume accounted for 59% of the effect of hospital volume for urgent and emergent admissions and 20% for readmissions. After all other variables were controlled for, there was no significant association between hospital or surgeon volume and in-hospital mortality or CNS complications; however, surgery at high-volume hospitals was associated with significantly lower hospital-related costs (P < .001).


CONCLUSIONS
These data suggest increased centralization of vestibular schwannoma surgery, with an increase in cases performed by intermediate- and high-volume providers and meaningful differences in high-volume surgical care that are mediated by surgeon volume and are associated with reduced hospital-related costs. Further investigation is warranted.
Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Bryan K
BK
Ward
Christine G
CG
Gourin
Howard W
HW
Francis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000601:surgery*; D010036:Otolaryngology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult