The quality of the operative report for women with ovarian cancer in Ontario.
OBJECTIVE
To assess the quality of the operative reports from cases of ovarian cancer surgery in Ontario.


METHODS
We undertook a population cohort study including all newly diagnosed ovarian cancer patients treated initially with surgery from January 1996 to December 1998 in Ontario (n = 1341). We abstracted charts from hospitals and cancer centres. All surgical and pathology notes were abstracted into an ACCESS database.


RESULTS
A total of 1,341 women had surgery as the first step in management of ovarian cancer. A vertical abdominal incision was used in 87.6% of these cases. Peritoneal cytology was obtained in 87.8% of cases overall, but in only 69.5% of stage 1 cases. A description of the ovaries was provided in 85% of reports, of the uterus in 70%, the diaphragm in 53%, the liver in 69%, the pelvic lymph nodes in 10%, and the para-aortic lymph nodes in 41%. In stage 1 cases, the ovaries were assessed histologically in 89% of cases, the uterus in 80%, the omentum in 69%, the peritoneum in 20%, the appendix in 9%, the pelvic lymph nodes in 10%, and the para-aortic lymph nodes in 7%. Frozen section was obtained in half of the stage 1 cases, and the false negative rate for identifying malignancy was 6%. In all, 23% of women received adequate surgical staging for stage 1 disease, and 12% of women with advanced disease had optimal debulking (to less than 1 cm residual disease). There are clear differences between centres with a gynaecologic oncologist on staff and other centres in the adequacy of surgical staging in women with stage 1 disease (chi2 = 60.6, P < 0.0001) and in optimal debulking for advanced disease (chi2 = 39.1, P < 0.0001). In 40% of cases with advanced disease, the amount of residual disease following surgery is not reported.


CONCLUSIONS
The current approach of dictating operative notes does not provide sufficient detail in a large number of cases; this affects treatment decisions and limits our ability to assess quality indicators for operative care in ovarian cancer. This problem is pervasive but is more significant in centres without a gynaecologic oncologist.
Elit
Laurie
L
Department of Obstetrics and Gynecology, McMaster University, Hamilton ON.
Bondy
Susan
S
Department of Public Health Sciences, University of Toronto, Toronto ON; Institute for Clinical Evaluative Sciences, Toronto ON.
Chen
Zhongliang
Z
Institute for Clinical Evaluative Sciences, Toronto ON.
Law
Calvin
C
Institute for Clinical Evaluative Sciences, Toronto ON; Department of General Surgery, University of Toronto, Toronto ON.
Paszat
Lawrence
L
Institute for Clinical Evaluative Sciences, Toronto ON; Department of Radiation Oncology, University of Toronto, Toronto ON; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto ON.
D015331:Cohort Studies; D005260:Female; D006801:Humans; D008499:Medical Records / Q000592:standards*; D009367:Neoplasm Staging; D009864:Ontario; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*