title: Quality Indicators for Head and Neck Oncologic Surgery: Academic versus Nonacademic Outcomes.
abstract: to determine national benchmarks for established quality indicators in head and neck cancer (HNCA) surgery, focusing on differences between academic and nonacademic institutions.
  
  
  
  Cross-sectional analysis of national database.
  
  
  
  HNCA surgery admissions from the 2009-2011 Nationwide Inpatient Sample were analyzed for preoperative characteristics and postoperative outcomes. Multivariate analyses were used to identify factors influencing quality indicators after HNCA surgery. Quality metrics-including length of stay (LOS), inpatient death, return to the operating room (OR), wound infection, and transfusion-were compared for academic versus nonacademic institutions.
  
  
  
  A total of 38,379 HNCA surgery inpatient admissions (mean age, 56.5 years; 52.4% male) were analyzed (28,288 teaching vs 10,091 nonteaching). Nationally representative quality metrics for HNCA surgery were as follows: mean LOS, 4.26 ± 0.12 days; return to OR, 3.3% ± 0.2%; inpatient mortality, 0.7% ± 0.1%; wound infection rate, 0.9% ± 0.1%; wound complication rate, 4.3% ± 0.2%; and transfusion rate, 4.3% ± 0.3%. HNCA surgery patients at teaching hospitals had a greater proportion of males, radiation history, and high-acuity procedures and greater comorbidity scores (all P < .001). Multivariate analyses adjusting for age, sex, income, payer, prior radiation, comorbidity scores, and procedural acuity demonstrated that teaching hospitals had a slightly increased LOS (+0.30 days; P = .009) and odds ratio for wound infection (1.54; 95% CI: 1.22-1.94) versus nonteaching hospitals. There were no significant differences in return to OR (P = .271), inpatient mortality (P = .686), or transfusion rate (P = .960).
  
  
  
  Despite caring for substantially more complex HNCA surgery patients with greater comorbidities, teaching hospitals demonstrate only a marginally increased LOS and wound complication rate versus nonteaching hospitals, while other established quality metrics are similar.
authors.affiliation: Department of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA Sid_Puram@meei.harvard.edu.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sidharth V
authors.initials: SV
authors.lastname: Puram
authors.affiliation: Department of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D019985:Benchmarking; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: academic; head and neck; otolaryngology; quality outcomes; teaching