Temporal trends in head and neck cancer surgery reconstruction.

BACKGROUND The purpose of this study was to analyze changing trends in head and neck cancer reconstructive surgery and analyze the effect of surgeon and hospital volume. METHODS Data from the Nationwide Inpatient Sample (NIS) for 133,850 patients who underwent a major ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 1993 to 2010 were analyzed using cross-tabulations and multivariate regression. RESULTS Reconstructive surgery in 2001 to 2010 was significantly associated with prior radiation (odds ratio [OR] = 2.6; 95% confidence interval [95% CI] = 1.4-4.9), comorbidity (OR = 1.6; 95% CI = 1.1-2.2), laryngeal cancer (OR = 0.7; 95% CI = 0.6-0.9), oropharyngeal cancer (OR = 0.5; 95% CI = 0.4-0.7), high-volume hospitals (OR = 3.9; 95% CI = 1.5-10.2), and high-volume surgeons (OR = 2.0; 95% CI = 1.1-3.9), compared to 1993-2000. Reconstruction by high-volume surgeons was significantly associated with prior radiation (OR = 1.8; 95% CI = 1.1-3.1) and lower in-hospital mortality (OR = 0.3; 95% CI = 0.1-1.0). A statistically significant negative correlation was observed between high-volume surgeons and length of hospitalization and hospital-related costs. CONCLUSION These data reflect changing trends in head and neck cancer reconstructive surgery, with meaningful differences in the type of surgical care provided by high-volume surgeons.