title: Ovarian cancer surgery in Maryland: volume-based access to care.
abstract: OBJECTIVE
  To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume.
  
  
  METHODS
  The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (</=4), intermediate (5-9), or high (>/=10). Annual hospital case volume was categorized as low (</=9), intermediate (10-19), or high (>/=20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care.
  
  
  RESULTS
  Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3%), intermediate (9.2%), and high (34.5%). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95% CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence >/=50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6%), intermediate (27.6%), and high (22.8%). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95% CI = 0.30-0.50, P < 0.0001).
  
  
  CONCLUSIONS
  A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.
authors.affiliation: Department of Biostatistics, Johns Hopkins Oncology Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. rbristo@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Mariana L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
authors.forename: Toby A
authors.initials: TA
authors.lastname: Gordon
authors.forename: Harold E
authors.initials: HE
authors.lastname: Fox
authors.forename: Edward L
authors.initials: EL
authors.lastname: Trimble
authors.forename: F J
authors.initials: FJ
authors.lastname: Montz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007044:Hysterectomy / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D016015:Logistic Models; D008396:Maryland; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards / Q000639:trends