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High-volume hospitals show better mortality rates for ovarian cancer
Patients with ovarian cancer treated at high-volume hospitals had lower mortality rates than similar patients treated at low-volume hospitals, according to data from a study.
The association between high surgical volume and improved outcomes from procedures is well documented. The effect of hospital volumes on patients with ovarian cancer remains unclear.
An important factor influencing mortality is not whether a patient has a complication, but whether patients with a complication are properly managed. High-volume hospitals may not necessarily have lower complication rates, but they may be better at rescuing patients from complications, according to background information provided by researchers.
Jason D. Wright
Jason D. Wright, MD, assistant professor in the department of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, and colleagues examined the role of complications, “failure to rescue” from complications and mortality based on hospital volume for patients with ovarian cancer.
For the study, Wright and colleagues used Nationwide Inpatient Sample (NIS) data to identify women aged 18 to 90 years who underwent surgery for ovarian cancer from 1988 to 2009. The NIS data identified 36,624 patients treated at 1,166 hospitals.
Wright and colleagues ranked hospitals based on procedure volume. They determined the risk-adjusted mortality, major complication rate and failure-to-rescue rate. Researchers then compared results of univariate and multivariate analyses.
The data indicated a mortality rate of 1.6% and overall complication rate of 22.8% for the cohort.
Results showed the major complication rate was 20.4% at low-volume hospitals, 23.4% for intermediate-volume and 24.6% for high-volume hospitals (P<.001).
Patients who experienced a complication at low-volume hospitals were more likely to die as a result of the complication, results showed.
The rate of death after a complication (failure to rescue) was considerably greater at low-volume hospitals compared with high-volume hospitals (8% vs. 4.9%; P<.001).
The improved survival for patients with ovarian cancer treated at high-volume hospitals was not due to a lower complication rate. Instead, failure to rescue was a major source of volume-based variation in outcomes for women with ovarian cancer, the results showed.
After accounting for patient and hospital characteristics, women treated at low-volume hospitals who experienced a complication were 48% more likely to die than patients with a complication at a high-volume hospital (OR=1.48; 95% CI, 1.11-1.99).
“Our finding that failure to rescue after postoperative complications is a major source of mortality at low-volume hospitals suggests that targeted initiatives to improve the quality of care for patients with complications may improve outcomes,” Wright and colleagues concluded.
Disclosure: The researchers report no relevant financial disclosures.