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.