J Neurol Surg B Skull Base 2022; 83(03): 270-280
DOI: 10.1055/s-0040-1721823
Original Article

The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature

1   Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
,
Rahul K. Sharma*
2   Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
,
Shivangi Lohia
1   Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
,
Marc A. Cohen
1   Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
› Author Affiliations

Abstract

Objective The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy.

Design  Systematic review of the literature.

Setting This review included national database and multi-institutional studies published between 1990 and 2019.

Participants PubMed was interrogated for keywords “hospital volume,” “facility volume,” and outcomes for “Nasopharyngeal carcinoma,” “Sinonasal carcinomas,” “Pituitary Tumors,” “Acoustic Neuromas,” “Chordomas,” and “Skull Base Tumors” to identify studies. Single-institution studies and self-reported surveys were excluded.

Main outcome measures The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications.

Results A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations.

Conclusion This systematic review demonstrates that a positive volume–outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes.

Note

This study was presented as a podium presentation at the National American Skull Base Surgery (NASBS) Annual Meeting on February 7th, 2020 in San Antonio, TX.


* Stephanie Flukes and Rahul K. Sharma are co-first authors.




Publication History

Received: 02 March 2020

Accepted: 25 September 2020

Article published online:
19 January 2021

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