title: Hospital volume and failure to rescue after head and neck cancer surgery.
abstract: OBJECTIVE
  To investigate the relationship between hospital volume and mortality, complications, and failure-to-rescue rates among patients undergoing head and neck cancer (HNCA) surgery.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Nationwide Inpatient Sample.
  
  
  METHODS
  Discharge data for 159,301 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm from 2001 to 2010 were analyzed using cross-tabulations and multivariate regression modeling. Failure to rescue was defined as death after a major complication, including acute myocardial infarction, acute renal failure, venous thromboembolism, pneumonia, gastrointestinal bleed, pulmonary failure, hemorrhage, or surgical site infection. We compared the incidence of mortality, major complications, and failure-to-rescue rates across hospital volume tertiles.
  
  
  RESULTS
  The majority of hospitals performing HNCA surgery were low-volume hospitals, which performed a mean of 6 HNCA cases per year (n = 7635). Intermediate-volume hospitals performed a mean of 37 cases per year (n = 729), and high-volume hospitals performed a mean of 131 cases (n = 207). High-volume hospital care was associated with significantly decreased odds of death (odds ratio, 0.56; 95% confidence interval, 0.46-0.86) and failure to rescue (odds ratio, 0.56; 95% confidence interval, 0.33-0.97) compared to low-volume hospital care. However, there was no significant difference in major complication rates between patients undergoing HNCA surgery at high-volume hospitals and those at low-volume hospitals.
  
  
  CONCLUSIONS
  Patients with HNCA who receive care at high-volume hospitals compared with low-volume hospitals have a 44% lower odds of mortality, which appears to be associated with differences in the response to and management of complications rather than differences in complication rates.
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors: Carolyn L
authors: CL
authors: Mulvey
authors: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, Maryland.
authors: Peter J
authors: PJ
authors: Pronovost
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland cgourin1@jhmi.edu.
authors: Christine G
authors: CG
authors: Gourin
mesh_terms: D003430:Cross-Sectional Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*
keywords: Nationwide Inpatient Sample; complications; failure to rescue; hospital volume; mortality; surgery