Ovarian cancer patients have lower mortality rates when treated at high-volume hospitals

November 8, 2012

A study by researchers at the Herbert Irving Comprehensive Cancer Center (HICCC) at NewYork-Presbyterian/Columbia University Medical Center, recently e-published ahead of print by the Journal of Clinical Oncology, suggests that women who have surgery for ovarian cancer at high-volume hospitals have superior outcomes than similar patients at low-volume hospitals.

The improved survival rate is not dependent on a lower rate of complications following surgery, but on the treatment of the complications. In fact, patients with a complication after surgery at a low-volume hospital are nearly 50 percent more likely to die as a result of the complication than patients seen at high-volume hospitals.

"It is widely documented that surgical volume has an important effect on outcomes following surgery," said lead author Jason D. Wright, MD, the Levine Family Assistant Professor of Women's Health and the Florence Irving Assistant Professor of at CUMC, a at NYP/Columbia, and a member of the HICCC.

"We examined three specific areas: the influence of hospital volume on complications, failure to rescue from complications, and inpatient mortality in patients who underwent cancer-related surgery," said Dr. Wright. "But the mortality rate did not coincide with the complication rate. For women who experienced a complication at a low-volume hospital, the mortality rate was 8 percent. For women at a high-volume hospital, it was 4.9 percent. After adjusting for variables, we concluded that the failure-to-rescue rate was 48 percent higher at low-volume hospitals than at high-volume hospitals. In short, high-volume hospitals are better able to rescue patients with complications following ovarian ."

The researchers used National Inpatient Sample data from 1998 to 2009, specifically, women aged 18 to 90 with ovarian cancer who under oophorectomy (removal of one or both ): a total of more than 36,000 patients treated at 1,166 hospitals. After reviewing the data, the researchers noted several significant trends. For example, the increased with surgical volume: 20.4 percent for patients at low-volume hospitals, compared with 24.6 percent at high-volume hospitals.

Although the researchers could not account for all possible factors influencing these findings—the NIS lacks data on physician characteristics and does not have data covering all US hospitals, for example—their findings have important implications for the care of patients with ovarian cancer.

"Our findings suggest that targeted initiatives to improve the care of patients with complications can improve outcomes," said Dawn L. Hershman, MD, associate professor of medicine and epidemiology at CUMC, an oncologist at NYP/Columbia, co-leader of the Breast Cancer Program at the HICCC, and a co-author of the study. "We also believe in the importance of adhering to quality guidelines and best practices, which may overcome these volume-based disparities.

"And at the most basic level, the findings highlight the importance of preventing complications to begin with. They increase mortality, in the worst-case scenario, but can also cause long-term medical problems, with patients and families facing difficult treatment choices and additional costs," said Dr. Hershman.

Explore further: Surgeon experience affects complication rate of spinal stenosis surgery

More information: The paper is titled "Failure to Rescue As a Source of Variation in Hospital Mortality for Ovarian Cancer." jco.ascopubs.org/content/early … 3.2906.full.pdf+html

Related Stories

Surgeon experience affects complication rate of spinal stenosis surgery

June 7, 2012
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, ...

Surgery deaths drop nationwide for high-risk surgeries: study

June 1, 2011
Surgery death rates have dropped nationwide over the past decade, according to a University of Michigan Health System study that reveals cancer surgeries have seen the most dramatic improvement in safety.

Joint replacement surgery riskier at hospitals with low surgical volume

June 7, 2011
Patients who undergo elective total hip or total knee arthroplasty at hospitals with lower surgical volume had a higher risk of venous thromboembolism and mortality following the procedure. The complications following joint ...

Recommended for you

Major study of genetics of breast cancer provides clues to mechanisms behind the disease

October 23, 2017
Seventy-two new genetic variants that contribute to the risk of developing breast cancer have been identified by a major international collaboration involving hundreds of researchers worldwide.

Proton therapy lowers treatment side effects in pediatric head and neck cancer patients

October 23, 2017
Pediatric patients with head and neck cancer can be treated with proton beam therapy (PBT) instead of traditional photon radiation, and it will result in similar outcomes with less impact on quality of life. Researchers from ...

New study shows how cells can be led down non-cancer path

October 23, 2017
As cells with a propensity for cancer break down food for energy, they reach a fork in the road: They can either continue energy production as healthy cells, or shift to the energy production profile of cancer cells. In a ...

Microbiologists contribute to possible new anti-TB treatment path

October 23, 2017
As part of the long effort to improve treatment of tuberculosis (TB), microbiologists led by Yasu Morita at the University of Massachusetts Amherst report that they have for the first time characterized a protein involved ...

Big Data shows how cancer interacts with its surroundings

October 23, 2017
By combining data from sources that at first seemed to be incompatible, UC San Francisco researchers have identified a molecular signature in tissue adjacent to tumors in eight of the most common cancers that suggests they ...

Symptom burden may increase hospital length of stay, readmission risk in advanced cancer

October 23, 2017
Hospitalized patients with advanced cancer who report more intense and numerous physical and psychological symptoms appear to be at risk for longer hospital stays and unplanned hospital readmissions. The report from a Massachusetts ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.