Regionalization of care for women with ovarian cancer

Long-term outcomes for women with ovarian cancer are improved when they are treated at high volume hospitals by high volume surgeons. We examined changes over time in surgeon and hospital procedural volume for ovarian cancer and explored the association between volume and perioperative outcomes.

The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to examine women with ovarian cancer who underwent surgery from 2000 to 2014. Annualized surgeon and hospital procedural volume were estimated and each grouped into quartiles. Changes over time in the annual number of surgeons and hospitals rendering care were estimated. The association between surgeon and hospital volume and perioperative morbidity and mortality were analyzed.

We identified 25,044 patients treated by 2728 surgeons at 213 hospitals. The number of surgeons decreased from 598 surgeons with 1737 patients (mean cases = 3) in 2000, to 278 surgeons who operated on 1503 patients (mean cases = 5) (P < 0.001) in 2014, while the mean hospital volume rose from 10 cases to 15 cases over the same time period (P < 0.001). There was no difference in morbidity based on surgeon volume (RR = 0.99 for high vs .low volume; 95% CI, 0.91-1.07) while perioperative mortality rates decreased with increasing surgeon volume quartile from 2.6% to 1.9%, 1.3% and 1.3%, respectively (P < 0.001). Similarly, there was no association between hospital volume and morbidity (RR = 1.00; 95% CI, 0.88-1.15). In contrast, the mortality rate declined with volume quartile from 2.5% in the lowest volume quartile to 0.9% in the highest volume quartile (P < 0.001).

The surgical care of women with ovarian cancer has been concentrated to a smaller number of surgeons and hospitals over time. There was a modest association between increased surgeon and hospital volume and decreased perioperative mortality.