http://pubs.jamanetwork.com/ en-us Fri, 01 Jun 2012 00:00:00 GMT Tue, 01 Jan 2013 00:43:43 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1182904 Fri, 01 Jun 2012 00:00:00 GMT Ward BK, Gourin CG, Francis HW. <span class="paragraphSection"><div class="boxTitle">Objective</div>To characterize contemporary practice patterns and outcomes of vestibular schwannoma surgery.<div class="boxTitle">Design</div>Cross-sectional analysis.<div class="boxTitle">Setting</div>Maryland Health Service Cost Review Commission database.<div class="boxTitle">Patients</div>The study included patients who underwent surgery for vestibular schwannoma between 1990 and 2009.<div class="boxTitle">Main Outcome Measures</div>Temporal trends and relationships between volume and in-hospital deaths, central nervous system (CNS) complications, length of hospitalization, and costs.<div class="boxTitle">Results</div>A total of 1177 surgical procedures were performed by 57 surgeons at 12 hospitals. Most cases were performed by high-volume surgeons (47%) at high-volume hospitals (79%). The number of cases increased from 474 in 1999-2000 to 703 in 2000-2009. Vestibular schwannoma surgery in 2000-2009 was associated with a decrease in CNS complications (odds ratio [OR] 0.4; P < .001) and an increase in cases performed by intermediate-volume (OR, 4.2; P = .002) and high-volume (OR, 3.2; P = .005) hospitals and intermediate-volume (OR, 1.9; P = .004) and high-volume (OR, 1.8; P = .006) surgeons. High-volume care was inversely related to the odds of urgent and emergent surgery (OR, 0.2; P < .001) and readmissions (OR, 0.1; P = .02). Surgeon volume accounted for 59% of the effect of hospital volume for urgent and emergent admissions and 20% for readmissions. After all other variables were controlled for, there was no significant association between hospital or surgeon volume and in-hospital mortality or CNS complications; however, surgery at high-volume hospitals was associated with significantly lower hospital-related costs (P < .001).<div class="boxTitle">Conclusions</div>These data suggest increased centralization of vestibular schwannoma surgery, with an increase in cases performed by intermediate- and high-volume providers and meaningful differences in high-volume surgical care that are mediated by surgeon volume and are associated with reduced hospital-related costs. Further investigation is warranted.</span> 138 6 577 583 10.1001/archoto.2012.877 http://pubs.jamanetwork.com/article.aspx?articleID=1182904