Treatment of complications has a greater impact on ovarian cancer mortality than case volume

Women who have surgery for ovarian cancer at high-volume hospitals have superior outcomes compared with similar patients at low-volume hospitals. This improved survival rate is dependent on the treatment of complications, and not on a lower rate of complications following surgery. At a low-volume hospital, a patient with a complication after surgery is nearly 50% more likely to die as a result of the complication than patients treated at high-volume hospitals.

The research team used National Inpatient Sample data from 1998 to 2009 on women age 18 to 90 years with ovarian cancer who underwent oophorectomy. This was more than 36,000 patients treated at 1,166 hospitals. This study considered three specific areas: the influence of hospital volume on complications, failure to rescue from complications, and inpatient mortality in ovarian cancer patients who underwent cancer-related surgery.

“The morality rate did not coincide with the complication rate,” explained lead author Jason D. Wright, MD, of Columbia University Medical Center.  “For women who experienced a complication at a low-volume hospital, the mortality rate was 8%. For women at a high-volume hospital, it was 4.9%. 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 cancer surgery.”

The complication rate increased with surgical volume, from 20.4% for patients at low-volume hospitals to 24.6% for patients at high-volume hospitals. While the data has limitations, such as lacking information on patients characteristics and not covering all US hospitals, the findings have important implications for 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, also of Columbia University Medical Center 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.

This study was published in Journal of Clinical Oncology (2012; doi:10.1200/JCO.2012.43.2906).
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