{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:10:31Z","timestamp":1760983831048},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2010,12,1]],"date-time":"2010-12-01T00:00:00Z","timestamp":1291161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>Positive volume\u2010outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of laryngeal cancer surgery by hospital and surgeon volume are poorly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon laryngeal cancer surgical case volumes from 1990 to 2009.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Overall, 1,981 laryngeal cancer surgeries were performed by 288 surgeons at 41 hospitals. Cases performed by high\u2010volume surgeons increased from 19% in 1990 to 1999 to 35% in 2000 to 2009 (odds ratio [OR] = 3.0, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001), whereas cases performed at high\u2010volume hospitals increased from 33% to 39% (OR = 2.0, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001). High\u2010volume surgeons were more likely to perform total laryngectomy (OR = 1.7, <jats:italic>P<\/jats:italic> = .001) and neck dissection (OR = 1.7, <jats:italic>P<\/jats:italic> = .002). High\u2010volume hospitals were significantly associated with total laryngectomy (OR = 2.0, <jats:italic>P<\/jats:italic> = .003), neck dissection (OR = 1.8, <jats:italic>P<\/jats:italic> = .038), flap reconstruction (OR = 5.1, <jats:italic>P<\/jats:italic> = .021), prior radiation (OR = 3.0, <jats:italic>P<\/jats:italic> = .031), and increased mortality risk scores (OR = 3.2, <jats:italic>P<\/jats:italic> = .006). After controlling for other variables, laryngeal cancer surgery in 2000 to 2009 was associated with increased access to high\u2010volume surgeons (OR = 1.9, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001) and high\u2010volume hospitals (OR = 1.3, <jats:italic>P<\/jats:italic> = .040), a decrease in partial and total laryngectomy procedures (OR = 0.2, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001), an increase in neck dissection (OR = 2.2, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic> 0.001), an increase in prior radiation (OR = 3.0, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001), increased case complexity scores (OR = 5.7, <jats:italic>P<\/jats:italic><jats:italic>&lt;<\/jats:italic>.001), and an increase in wound fistula or dehiscence (OR = 2.0, <jats:italic>P<\/jats:italic> = .015) compared with 1990 to 1999.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>The proportion of laryngeal cancer surgery patients treated by high\u2010volume surgeons and hospitals increased significantly in 2000 to 2009 compared with 1990 to 1999, with a decrease in laryngectomy procedures and an increase in wound complications. These findings may be due to changing trends in primary management of laryngeal cancer. 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