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Outcomes in surgery for ovarian cancer

Elit L, Bondy S, Paszat L, Przbysz R, Levine M. Outcomes in surgery for ovarian cancer. Gynecol Oncol.  2002; 87 (3): 260-267.

The objective was to determine the relationship among hospital volume of ovarian cancer surgery, academic status of institution, surgical specialty, and outcomes of care (30-day postoperative mortality, reoperation rate, and overall survival). This was a population-based cohort study that included all newly diagnosed ovarian cancer patients treated from 1992 to 1998 in Ontario, Canada. Hospitalization and surgical billing databases were used. Logistic regression was used to evaluate the importance of hospital type, hospital volume, surgical specialty, and surgeon volume of ovarian cancer operations on postoperative mortality, reoperation rates, and survival. Ovarian cancer surgery was performed on 3815 women between April 1992 and March 1998. When data were adjusted for age, comorbidity, acuity of the operation, and metastatic disease, no factors influenced postoperative mortality. The adjusted relative risk for reoperation within 3 months of the initial surgery showed that patients were less likely to have a repeat operation if the initial operation was done in a high- or intermediate-volume hospital, a hospital with a gynecologic oncologist, by a gynecologic oncologist or gynecologist, or by a high-volume surgeon. The adjusted survival was improved if the initial surgery was done by a gynecologic oncologist or gynecologist. There is a relationship between hospital volume and reoperation rate. Institution type only influenced reoperation rate. Statistically significant associations were found between surgical specialty and all three outcome variables. The volume of surgery performed by an individual surgeon only influenced reoperation rate. The results are preliminary but support the need for further studies examining factors such as cancer stage.


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