title: Uterine cancer in Maryland: impact of surgeon case volume and other prognostic factors on short-term mortality.
abstract: OBJECTIVE
  To characterize the patterns of primary surgical care and short term outcomes for uterine cancer according to surgeon and hospital case volume.
  
  
  METHODS
  A statewide hospital discharge database was used to identify women undergoing primary surgery for uterine cancer during 1994-2005. Surgeon case volume was categorized as low (<or=99 cases/12 years), or high (>or=100 cases/12 years). Hospital case volume was categorized as low (<or=199 cases/12 years), or high (>or=200 cases/12 years). Logistic regression models were used to evaluate for significant factors associated with in-hospital death and access to high volume care.
  
  
  RESULTS
  Overall, 6,181 cases for uterine cancer were performed by 894 surgeons at 49 hospitals. Low volume surgeons performed 62.4% of the cases. Management by high volume surgeons was associated with a 53% reduction in the risk of the case being managed by different attending physician/surgeon (95% CI 0.38-0.57, p<0.00). In contrast, 90.5% of cases were performed at high volume hospitals. Management by different attending physician/surgeon was associated with a 2.6 increase in the risk of in hospital death (95%CI 1.41-4.79, p=0.00). Surgery performed by high-volume surgeons was associated with a 48% reduction in the risk of in-hospital death (95%CI 0.26-1.00, p=0.05).
  
  
  CONCLUSIONS
  Surgical management of uterine cancer by high volume surgeons is associated with a decrease risk in in-hospital death. Increased efforts to concentrate the surgical management of uterine cancer by high volume surgeons at high volume centers should be undertaken.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA. tdiazmo1@jhmi.edu
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Díaz-Montes
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008396:Maryland / Q000453:epidemiology; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000209:etiology / Q000401:mortality* / Q000601:surgery*