Neck dissections in the United States from 2000 to 2006: volume, indications, and regionalization.

BACKGROUND The purpose of this study was to examine trends in neck dissection and regionalization. METHODS This cross-sectional and longitudinal study used the years 2000, 2004, and 2006 data from the Nationwide Inpatient Sample. Chi-square tests compared trends for total neck dissections and specific subsites. To test regionalization, we examined the distribution of procedures across hospital and procedure volume quartiles. RESULTS From 2000 to 2006, the number of neck dissections increased from 18,112 to 22,918. Three-fourths of the total increase was associated with thyroid and parathyroid gland or skin neoplasms. There was an increase in neck dissections for upper aerodigestive tract (UADT) subsites and no decline for the oropharynx and tongue base. Regionalization occurred as high-volume hospitals and providers performed a greater proportion of neck dissections over time. CONCLUSION Neck dissections increased from the year 2000 to 2006. There were no decreases in neck dissections for certain subsites with a greater role for primary chemoradiotherapy. Regionalization has occurred.