OBJECTIVE: We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancer patients. METHODS: Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals and gynecologists were classified according to specialization (general, semi-specialized or specialized) and by volume (<or=6, 7-12, or >12 cases/year). Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival. Data were analyzed using multivariable logistic regression (surgical results) and Cox regression (survival). RESULTS: The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients (adjusted odds ratio (OR) specialized hospitals 3.9 (95% confidence interval (CI) 2.0-7.6); specialized gynecologists 9.5 (95% CI 4.7-19)). Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals (adjusted OR 1.7 (95% CI 1.1-2.7)) or by high volume gynecologists (adjusted OR 2.8 (95% CI 1.4-5.7)). Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists. CONCLUSION: The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival. Concentration of ovarian cancer care thus seems warranted.
OBJECTIVE: We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancerpatients. METHODS: Data were collected from 1077 ovarian cancerpatients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals and gynecologists were classified according to specialization (general, semi-specialized or specialized) and by volume (<or=6, 7-12, or >12 cases/year). Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival. Data were analyzed using multivariable logistic regression (surgical results) and Cox regression (survival). RESULTS: The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients (adjusted odds ratio (OR) specialized hospitals 3.9 (95% confidence interval (CI) 2.0-7.6); specialized gynecologists 9.5 (95% CI 4.7-19)). Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals (adjusted OR 1.7 (95% CI 1.1-2.7)) or by high volume gynecologists (adjusted OR 2.8 (95% CI 1.4-5.7)). Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists. CONCLUSION: The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival. Concentration of ovarian cancer care thus seems warranted.
Authors: Jason D Wright; Yongmei Huang; Alexander Melamed; Ana I Tergas; Caryn M St Clair; June Y Hou; Fady Khoury-Collado; Cande V Ananth; Alfred I Neugut; Dawn L Hershman Journal: Obstet Gynecol Date: 2019-06 Impact factor: 7.661
Authors: Renee A Cowan; Roisin E O'Cearbhaill; Ginger J Gardner; Douglas A Levine; Kara Long Roche; Yukio Sonoda; Oliver Zivanovic; William P Tew; Evis Sala; Yulia Lakhman; Hebert A Vargas Alvarez; Debra M Sarasohn; Svetlana Mironov; Nadeem R Abu-Rustum; Dennis S Chi Journal: Ann Surg Oncol Date: 2015-10-28 Impact factor: 5.344
Authors: Michael J Worley; Carlos Anwandter; Charlotte C Sun; Ricardo dos Reis; Alpa M Nick; Michael Frumovitz; Pamela T Soliman; Kathleen M Schmeler; Charles F Levenback; Mark F Munsell; Pedro T Ramirez Journal: Gynecol Oncol Date: 2012-01-10 Impact factor: 5.482
Authors: Anna B Beckmeyer-Borowko; Caryn E Peterson; Katherine C Brewer; Mary A Otoo; Faith G Davis; Kent F Hoskins; Charlotte E Joslin Journal: Cancer Causes Control Date: 2016-09-02 Impact factor: 2.506
Authors: William A Cliby; Matthew A Powell; Noor Al-Hammadi; Ling Chen; J Philip Miller; Phillip Y Roland; David G Mutch; Robert E Bristow Journal: Gynecol Oncol Date: 2014-10-29 Impact factor: 5.482
Authors: Shamly Austin; Michelle Y Martin; Yongin Kim; Ellen M Funkhouser; Edward E Partridge; Maria Pisu Journal: Health Serv Res Date: 2012-12-03 Impact factor: 3.402
Authors: Alexi A Wright; Kari Bohlke; Deborah K Armstrong; Michael A Bookman; William A Cliby; Robert L Coleman; Don S Dizon; Joseph J Kash; Larissa A Meyer; Kathleen N Moore; Alexander B Olawaiye; Jessica Oldham; Ritu Salani; Dee Sparacio; William P Tew; Ignace Vergote; Mitchell I Edelson Journal: Gynecol Oncol Date: 2016-08-08 Impact factor: 5.482
Authors: Alexi A Wright; Kari Bohlke; Deborah K Armstrong; Michael A Bookman; William A Cliby; Robert L Coleman; Don S Dizon; Joseph J Kash; Larissa A Meyer; Kathleen N Moore; Alexander B Olawaiye; Jessica Oldham; Ritu Salani; Dee Sparacio; William P Tew; Ignace Vergote; Mitchell I Edelson Journal: J Clin Oncol Date: 2016-08-08 Impact factor: 44.544