Among adults undergoing vestibular schwannoma surgery, greater case volume at a facility was associated with a decreased risk for longer hospital stay or 30-day readmission, according to results published in JAMA Otolaryngology—Head and Neck Surgery.
Peter R. Dixon, MD, MSc, and colleagues assessed a primary composite outcome of prolonged hospital stay (>90th percentile) or 30-day read-mission among 11,524 patients at 66 reporting facilities. Median length of stay was 4 days, and 655 patients (5.7%) were readmitted within 30 days. Median case volume was 16 per year. An adjusted restricted cubic spline model detected a down-trending probability of excess time in the hospital with increasing volume. The decreasing risk for excess time in the hospital began to plateau at a facility volume of 25 cases per year. Surgery at a facility with an annual case volume at or above this point was independently associated with a 42% decrease in the odds of excess time in the hospital compared with surgery at a low-volume center (OR, 0.58; 95% CI, 0.44-0.77). “A facility case volume of 25 cases per year may represent a risk-defining threshold,” Dr. Dixon and colleagues wrote.
