Ovarian cancer surgery in Maryland: Volume-based access to care

Robert E. Bristow, Mariana L. Zahurak, Marcela G. Del Carmen, Toby A Gordon, Harold E. Fox, Edward Trimble, F. J. Montz

Research output: Contribution to journalArticle

Abstract

Purpose. To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume. Methods. The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (≤4), intermediate (5-9), or high (≥10). Annual hospital case volume was categorized as low (≤9), intermediate (10-19), or high (≥20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care. Results. Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3%), intermediate (9.2%), and high (34.5%). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95% CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence ≥50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6%), intermediate (27.6%), and high (22.8%). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95% CI = 0.30-0.50, P <0.0001). Conclusion. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.

Original languageEnglish (US)
Pages (from-to)353-360
Number of pages8
JournalGynecologic Oncology
Volume93
Issue number2
DOIs
StatePublished - May 2004

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Ovarian Neoplasms
High-Volume Hospitals
Low-Volume Hospitals
Operative Surgical Procedures
Logistic Models
Surgeons
Neoplasms
Primary Health Care
Databases
Population

Keywords

  • Access to care
  • Ovarian cancer
  • Surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Bristow, R. E., Zahurak, M. L., Del Carmen, M. G., Gordon, T. A., Fox, H. E., Trimble, E., & Montz, F. J. (2004). Ovarian cancer surgery in Maryland: Volume-based access to care. Gynecologic Oncology, 93(2), 353-360. https://doi.org/10.1016/j.ygyno.2004.02.010

Ovarian cancer surgery in Maryland : Volume-based access to care. / Bristow, Robert E.; Zahurak, Mariana L.; Del Carmen, Marcela G.; Gordon, Toby A; Fox, Harold E.; Trimble, Edward; Montz, F. J.

In: Gynecologic Oncology, Vol. 93, No. 2, 05.2004, p. 353-360.

Research output: Contribution to journalArticle

Bristow, RE, Zahurak, ML, Del Carmen, MG, Gordon, TA, Fox, HE, Trimble, E & Montz, FJ 2004, 'Ovarian cancer surgery in Maryland: Volume-based access to care', Gynecologic Oncology, vol. 93, no. 2, pp. 353-360. https://doi.org/10.1016/j.ygyno.2004.02.010
Bristow, Robert E. ; Zahurak, Mariana L. ; Del Carmen, Marcela G. ; Gordon, Toby A ; Fox, Harold E. ; Trimble, Edward ; Montz, F. J. / Ovarian cancer surgery in Maryland : Volume-based access to care. In: Gynecologic Oncology. 2004 ; Vol. 93, No. 2. pp. 353-360.
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abstract = "Purpose. To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume. Methods. The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (≤4), intermediate (5-9), or high (≥10). Annual hospital case volume was categorized as low (≤9), intermediate (10-19), or high (≥20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care. Results. Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3{\%}), intermediate (9.2{\%}), and high (34.5{\%}). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95{\%} CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence ≥50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6{\%}), intermediate (27.6{\%}), and high (22.8{\%}). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95{\%} CI = 0.30-0.50, P <0.0001). Conclusion. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.",
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AU - Bristow, Robert E.

AU - Zahurak, Mariana L.

AU - Del Carmen, Marcela G.

AU - Gordon, Toby A

AU - Fox, Harold E.

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AU - Montz, F. J.

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N2 - Purpose. To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume. Methods. The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (≤4), intermediate (5-9), or high (≥10). Annual hospital case volume was categorized as low (≤9), intermediate (10-19), or high (≥20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care. Results. Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3%), intermediate (9.2%), and high (34.5%). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95% CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence ≥50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6%), intermediate (27.6%), and high (22.8%). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95% CI = 0.30-0.50, P <0.0001). Conclusion. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.

AB - Purpose. To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume. Methods. The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (≤4), intermediate (5-9), or high (≥10). Annual hospital case volume was categorized as low (≤9), intermediate (10-19), or high (≥20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care. Results. Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3%), intermediate (9.2%), and high (34.5%). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95% CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence ≥50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6%), intermediate (27.6%), and high (22.8%). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95% CI = 0.30-0.50, P <0.0001). Conclusion. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.

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