title: Analysis of contemporary trends in access to high-volume ovarian cancer surgical care.
abstract: BACKGROUND
  Positive volume-outcome relationships exist for cancers treated with technically complex surgery, including ovarian cancer. However, contemporary patterns of primary surgical care for ovarian cancer according to hospital and surgeon case volume remain poorly defined.
  
  
  METHODS
  The Maryland Health Service Cost Review Commission database was accessed for annual hospital and surgeon primary ovarian cancer surgical case volume for 2001-2008 and evaluated for statistically significant trends in access to high-volume surgical care compared with the earlier period for 1990-2000. chi(2) and logistic regression analyses were used to evaluate for significant trends in case volume distribution over time as well as factors associated with access to high-volume care.
  
  
  RESULTS
  Overall, 2,475 primary ovarian cancer operations were performed by 472 surgeons at 43 hospitals. There was a statistically significant increase in the proportion of cases performed at high-volume centers from 22.8% in 1990-2000 to 61.1% in 2001-2008 (odds ratio = 5.30, 95% confidence interval = 4.68-6.00, P < .0001), while low-volume hospital case distribution decreased from 49.6 to 31.3%. Access to high-volume surgeons increased from 34.5% in 1990-2000 to 64.5% in 2001-2008 (odds ratio = 3.44, 95% confidence interval = 3.06-3.87, P < .0001), while the proportion of cases performed by low-volume surgeons decreased from 56.3 to 28.9%. After controlling for other variables, high-volume surgeons were significantly more likely to perform ovarian cancer surgery that included hysterectomy and staging/cytoreductive surgical procedures.
  
  
  CONCLUSIONS
  The proportions of ovarian cancer patients undergoing primary surgery at high volume centers and by high-volume surgeons increased statistically significantly from 1990-2000 to 2001-2008. Further investigation is necessary to determine factors contributing to this favorable trend.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. rbristo1@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Isha
authors.initials: I
authors.lastname: Puri
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz-Montes
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult