Analysis of contemporary trends in access to high-volume ovarian cancer surgical care.
ABSTRACT Positive volume-outcome relationships exist for cancers treated with technically complex surgery, including ovarian cancer. However, contemporary patterns of primary surgical care for ovarian cancer according to hospital and surgeon case volume remain poorly defined.
The Maryland Health Service Cost Review Commission database was accessed for annual hospital and surgeon primary ovarian cancer surgical case volume for 2001-2008 and evaluated for statistically significant trends in access to high-volume surgical care compared with the earlier period for 1990-2000. chi(2) and logistic regression analyses were used to evaluate for significant trends in case volume distribution over time as well as factors associated with access to high-volume care.
Overall, 2,475 primary ovarian cancer operations were performed by 472 surgeons at 43 hospitals. There was a statistically significant increase in the proportion of cases performed at high-volume centers from 22.8% in 1990-2000 to 61.1% in 2001-2008 (odds ratio = 5.30, 95% confidence interval = 4.68-6.00, P < .0001), while low-volume hospital case distribution decreased from 49.6 to 31.3%. Access to high-volume surgeons increased from 34.5% in 1990-2000 to 64.5% in 2001-2008 (odds ratio = 3.44, 95% confidence interval = 3.06-3.87, P < .0001), while the proportion of cases performed by low-volume surgeons decreased from 56.3 to 28.9%. After controlling for other variables, high-volume surgeons were significantly more likely to perform ovarian cancer surgery that included hysterectomy and staging/cytoreductive surgical procedures.
The proportions of ovarian cancer patients undergoing primary surgery at high volume centers and by high-volume surgeons increased statistically significantly from 1990-2000 to 2001-2008. Further investigation is necessary to determine factors contributing to this favorable trend.
[show abstract] [hide abstract]
ABSTRACT: Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined. The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009. Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P = .002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P < .001) and were more likely to perform partial glossectomy (OR = 1.8, P = .002), total glossectomy (OR = 3.8, P < .001), and neck dissection (OR = 2.3, P < .001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P < .001), partial glossectomy (OR = 1.4, P = .044), total glossectomy (OR = 4.3, P < .001), neck dissection (OR = 3.1, P < .001), flap reconstruction (OR = 1.9, P = .028), and prior radiation (OR = 5.0, P < .001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P < .001), increased mortality risk scores (OR = 3.1, P = .022), prior radiation (OR = 4.9, P = .011), and a decrease in partial glossectomy (OR = 0.5, P < .001), total glossectomy (OR = 0.4, P = .004), pharyngectomy (OR = 0.6, P = .007), and mandibulectomy (OR = 0.6, P = .022) procedures. The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.The Laryngoscope 03/2011; 121(4):738-45. · 1.75 Impact Factor