Limiting ovarian cancer surgery to high-volume hospitals could improve survival but may also reduce access for many rural and underserved patients. Epidemiologists Dr. Alfred Neugut and Dr. Dawn Hershman, at Columbia University Mailman School of Public Health and Columbia University Vagelos College of Physicians and Surgeons, co-authored the study published in Obstetrics & Gynecology. The research was led by Dr. Jason Wright, Columbia associate professor of gynecologic oncology.
Although mortality was higher than average at hospitals that performed 3 or fewer procedures, more than 75 percent of low-volume hospitals had better-than-expected outcomes at 60-days and 51 percent had better-than-expected outcomes at 2 years. Studies have shown that patients undergoing cancer surgery often have better outcomes when treated at hospitals that perform these procedures routinely.
Applying a minimum-volume cutoff of 3 procedures would prevent nearly 35 percent of hospitals, mainly in rural areas, from performing ovarian cancer surgery — affecting nearly 8 percent of patients.
The researchers used a national cancer database containing 136,196 women who were diagnosed with invasive ovarian cancer between 2005 and 2015 and the 1,321 hospitals that had treated them. They then compared the hospitals’ actual (observed) mortality rates with expected mortality rates and modeled how eliminating low-volume hospitals would affect outcomes.
A large number (nearly 50 percent) of hospitals performed 5 or less ovarian cancer surgeries in 2015, treating approximately 13 percent of all women with newly diagnosed ovarian cancer.
On average, hospitals performing 5 or less of these procedures had higher-than-expected mortality rates at 6 months, 1 year, 2 years, and 5 years after surgery.Friday Letter Submission, Publish on July 19