title: Total laryngectomy: national and regional case volume trends 1998-2008.
abstract: OBJECTIVE
  The management of advanced laryngeal cancer is evolving, with increasing use of chemoradiation as initial treatment. Recent reports confirm a decline in total laryngectomies (TLs) in the United States. A study was undertaken to evaluate national and regional trends in TLs performed over the most recent decade for which data were available and to use multivariate analysis to characterize these trends in more detail.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1998 to 2008.
  
  
  METHODS
  All patients underwent radical or complete laryngectomy. Descriptive statistics and linear and multivariate regressions were performed on both raw case volumes and nationally extrapolated figures.
  
  
  RESULTS
  In this nationally representative sample, 8288 TL cases met inclusion criteria between 1998 and 2008. The TL case volumes decreased by 27.3 per year (P = .005) and showed increasing trends in high-volume centers. The number of hospitals performing TLs decreased by 12.3 per year (P < .0005). The South and Midwest showed higher case volumes even after controlling for multiple covariates.
  
  
  CONCLUSIONS
  Total laryngectomy cases are decreasing and concentrating into high-volume centers. This study demonstrated unexplained regional variation in case volumes. These findings may affect patients, otolaryngology residency training, surgeons, and reimbursement.
authors.affiliation: Department of Surgery, Division of Head and Neck Surgery, University of California San Diego, San Diego, California, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Orosco
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weisman
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Brumund
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D007825:Laryngectomy / Q000639:trends*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology