Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?

Objective:

To determine the effect of hospital surgical case volume on the outcomes of vestibular schwannoma surgery.

Study Design:

Retrospective case review.

Setting:

University HealthSystem Consortium member hospitals (includes nearly every US academic medical center).Patients:

Three thousand six hundred ninety-seven patients who underwent vestibular schwannoma resection over a 3-year timespan (2012–2015) grouped by race, age, comorbidities, payer, and sex.

Intervention:

Surgical resection of vestibular schwannoma.

Main Outcome Measures:

Morbidity and mortality following vestibular schwannoma excision are compared by hospital volume (low, medium, and high) including deciles.Results:

There was significantly longer length of stay (p ≤ 0.005) among groups with low-volume hospitals followed by medium-volume hospitals and high-volume hospitals. Low-volume hospitals had a significantly higher rate of complications including stroke, aspiration, and respiratory failure (p ≤ 0.0175). Patient characteristics of age, sex, sex, and baseline comorbidities were similar between hospital groups. However, patients at high-volume hospitals were more likely to be Caucasian (83.1%, p = 0.0001) and have private insurance (76.7%, p < 0.0001). There was a strong negative correlation between complication rates and hospital volume (r = −0.8164, p = 0.0040).Conclusion:

The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.