title: Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands.
abstract: OBJECTIVE
  We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancer patients.
  
  
  METHODS
  Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals and gynecologists were classified according to specialization (general, semi-specialized or specialized) and by volume (<or=6, 7-12, or >12 cases/year). Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival. Data were analyzed using multivariable logistic regression (surgical results) and Cox regression (survival).
  
  
  RESULTS
  The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients (adjusted odds ratio (OR) specialized hospitals 3.9 (95% confidence interval (CI) 2.0-7.6); specialized gynecologists 9.5 (95% CI 4.7-19)). Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals (adjusted OR 1.7 (95% CI 1.1-2.7)) or by high volume gynecologists (adjusted OR 2.8 (95% CI 1.4-5.7)). Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists.
  
  
  CONCLUSIONS
  The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival. Concentration of ovarian cancer care thus seems warranted.
authors.affiliation: Department of Gynecological Surgery and Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. f.vernooij@umcutrecht.nl
authors.forename: Flora
authors.initials: F
authors.lastname: Vernooij
authors.forename: A Peter M
authors.initials: AP
authors.lastname: Heintz
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: Petronella O
authors.initials: PO
authors.lastname: Witteveen
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D006176:Gynecology / Q000592:standards; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome