title: Temporal trends in head and neck cancer surgery reconstruction.
abstract: BACKGROUND
  The purpose of this study was to analyze changing trends in head and neck cancer reconstructive surgery and analyze the effect of surgeon and hospital volume.
  
  
  METHODS
  Data from the Nationwide Inpatient Sample (NIS) for 133,850 patients who underwent a major ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 1993 to 2010 were analyzed using cross-tabulations and multivariate regression.
  
  
  RESULTS
  Reconstructive surgery in 2001 to 2010 was significantly associated with prior radiation (odds ratio [OR] = 2.6; 95% confidence interval [95% CI] = 1.4-4.9), comorbidity (OR = 1.6; 95% CI = 1.1-2.2), laryngeal cancer (OR = 0.7; 95% CI = 0.6-0.9), oropharyngeal cancer (OR = 0.5; 95% CI = 0.4-0.7), high-volume hospitals (OR = 3.9; 95% CI = 1.5-10.2), and high-volume surgeons (OR = 2.0; 95% CI = 1.1-3.9), compared to 1993-2000. Reconstruction by high-volume surgeons was significantly associated with prior radiation (OR = 1.8; 95% CI = 1.1-3.1) and lower in-hospital mortality (OR = 0.3; 95% CI = 0.1-1.0). A statistically significant negative correlation was observed between high-volume surgeons and length of hospitalization and hospital-related costs.
  
  
  CONCLUSIONS
  These data reflect changing trends in head and neck cancer reconstructive surgery, with meaningful differences in the type of surgical care provided by high-volume surgeons.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Gooi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.|Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kofi D O
authors.initials: KD
authors.lastname: Boahene
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Richmon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000639:trends*; D012044:Regression Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Nationwide Inpatient Sample; complications; costs; head and neck neoplasms; hospital-acquired conditions; surgery