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Oophorectomy outcomes better at high-volume hospitals

Sunday November 11, 2012
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Women who have surgery for ovarian cancer at high-volume hospitals have better outcomes than similar patients at low-volume hospitals, according to a study.

The improved survival rate is not dependent on a lower rate of complications following surgery, but on the treatment of the complications, reported researchers at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center.

In fact, patients with a complication after surgery at a low-volume hospital are nearly 50% more likely to die as a result of the complication than patients seen at high-volume hospitals.

"It is widely documented that surgical volume has an important effect on outcomes following surgery," Jason D. Wright, MD, the study’s lead author and the Levine Family Assistant Professor of Women’s Health and the Florence Irving Assistant Professor of Obstetrics and Gynecology at CUMC, said in a news release.

"We examined three specific areas: the influence of hospital volume on complications, failure to rescue from complications and inpatient mortality in ovarian cancer patients who underwent cancer-related surgery," added Wright, also a gynecologic oncologist at NYP/Columbia and a member of the HICCC. "But the mortality rate did not coincide with the complication rate."

The mortality rate was 8% for women who experienced a complication at a low-volume hospital, compared with 4.9% among women who experienced a complication at a high-volume hospital. Upon analyzing the data and adjusting for variables, the researchers concluded that the failure-to-rescue rate was 48% higher at low-volume hospitals.

"In short, high-volume hospitals are better able to rescue patients with complications following ovarian cancer surgery," Wright said.

The researchers used National Inpatient Sample data from 1998 to 2009, specifically, women ages 18 to 90 with ovarian cancer who under oophorectomy, for a total of more than 36,000 patients treated at 1,166 hospitals. The researchers could not account for all possible factors influencing these findings. For example, the NIS lacks data on physician characteristics and does not have data covering all U.S. hospitals.

Dawn L. Hershman, MD, a study coauthor and associate professor of medicine and epidemiology at CUMC, said the findings nonetheless have important implications.

"Our findings suggest that targeted initiatives to improve the care of patients with complications can improve outcomes," said Hershman, also an oncologist at NYP/Columbia and co-leader of the Breast Cancer Program at the HICCC. "We also believe in the importance of adhering to quality guidelines and best practices, which may overcome these volume-based disparities.

"And at the most basic level, the findings highlight the importance of preventing complications to begin with. They increase mortality, in the worst-case scenario, but can also cause long-term medical problems with patients and families facing difficult treatment choices and additional costs."

The study is scheduled for publication in the Journal of Clinical Oncology. The study abstract is available at http://jco.ascopubs.org/content/early/2012/10/01/JCO.2012.43.2906.abstract.


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