title: National trends in surgery for sinonasal malignancy and the effect of hospital volume on short-term outcomes.
abstract: OBJECTIVE
  To characterize trends in the management of sinonasal malignancy with a focus on the impact of hospital volume on surgical outcomes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Time trends were analyzed among patients admitted for surgical resection of sinonasal malignancy in the Nationwide Inpatient Sample (NIS) between 1988 and 2009. Subset analysis was performed on cohorts with skull base or orbital involvement or on cohorts who underwent neck dissection. Patient characteristics and hospital attributes were correlated with morbidity and mortality.
  
  
  RESULTS
  Over 22 years, we identified 3,850 cases from 879 hospitals. A total of 24.3% of patients had complications and 0.8% of hospitalizations resulted in mortality. Cases with skull base or orbital involvement, or cases including neck dissection, had more complications and a longer length of stay. Prevalence of neck dissection increased over time. Thirty-two hospitals averaged more than five cases per year, accounting for 28% of all surgeries. These centers were large (73.3%), urban (96.7%), teaching (90%) institutions and performed more high-risk cases: 32.4% of neck dissections, 44.6% of orbital cases, and 43.1% of skull base cases. Compared to lower-volume centers, these centers had more cardiopulmonary and electrolyte complications, but no difference was observed in the lengths of stay. A greater proportion of cases were recently performed at high-volume centers.
  
  
  CONCLUSIONS
  Over time, complicated surgeries were more likely to occur at higher-volume hospitals without significant changes in surgical complication rates. High-volume centers had increased rates of cardiopulmonary and electrolyte complications, likely representing complex postoperative management, but these were not associated with higher mortality.
  
  
  METHODS
  2c.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Ouyang
authors.forename: Ivan H
authors.initials: IH
authors.lastname: El-Sayed
authors.forename: Sue S
authors.initials: SS
authors.lastname: Yom
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009669:Nose Neoplasms / Q000453:epidemiology / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000639:trends*; D010255:Paranasal Sinus Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Nationwide Inpatient Sample; sinonasal cancer; surgery trends