Uterine cancer in Maryland: Impact of surgeon case volume and other prognostic factors on short-term mortality

Objectives.: To characterize the patterns of primary surgical care and short term outcomes for uterine cancer according to surgeon and hospital case volume. Methods.: A statewide hospital discharge database was used to identify women undergoing primary surgery for uterine cancer during 1994-2005. Surgeon case volume was categorized as low (≤ 99 cases/12 years), or high (≥ 100 cases/12 years). Hospital case volume was categorized as low (≤ 199 cases/12 years), or high (≥ 200 cases/12 years). Logistic regression models were used to evaluate for significant factors associated with in-hospital death and access to high volume care. Results.: Overall, 6,181 cases for uterine cancer were performed by 894 surgeons at 49 hospitals. Low volume surgeons performed 62.4% of the cases. Management by high volume surgeons was associated with a 53% reduction in the risk of the case being managed by different attending physician/surgeon (95%CI 0.38-0.57, p < 0.00). In contrast, 90.5% of cases were performed at high volume hospitals. Management by different attending physician/surgeon was associated with a 2.6 increase in the risk of in hospital death (95%CI 1.41-4.79, p = 0.00). Surgery performed by high-volume surgeons was associated with a 48% reduction in the risk of in-hospital death (95%CI 0.26-1.00, p = 0.05). Conclusions.: Surgical management of uterine cancer by high volume surgeons is associated with a decrease risk in in-hospital death. Increased efforts to concentrate the surgical management of uterine cancer by high volume surgeons at high volume centers should be undertaken.