title: Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes.
abstract: OBJECTIVE
  To evaluate the impact of surgeon and hospital case volume, and other related variables, on short-term outcomes after surgery for ovarian cancer.
  
  
  METHODS
  The Maryland Health Service Cost Review Commission database was accessed for ovarian cancer surgical cases including both oophorectomy and any staging/cytoreductive surgical procedure from 2001 to 2008. Multivariate logistic regression analyses and multiple linear regression models were used to evaluate for significant associations between surgeon and hospital case volume, as well as other independent variables, and the risk of in-hospital death, extent of surgery, length of hospital stay, and hospital-related cost of care.
  
  
  RESULTS
  Overall, 1894 primary ovarian cancer operations were performed by 352 surgeons at 43 hospitals. After controlling for the effects of all variables, the only independently significant factors associated with the risk of in-hospital death were surgery by a high-volume surgeon and an APR-DRG mortality risk score of 4. Ovarian cancer surgery performed by a high-volume surgeon was associated with a 69% reduction in the risk of in-hospital death. Surgery at a high-volume hospital was an independent positive predictor of a cytoreductive procedure. A statistically significant negative correlation was observed between surgery at a high-volume hospital and both length of hospital stay and hospital-related cost.
  
  
  CONCLUSIONS
  After controlling for other factors, ovarian cancer surgery performed by a high-volume surgeon is associated with a 69% reduction in the risk of in-hospital death, while high-volume hospital care is associated with increased likelihood of cytoreduction, shorter length of stay, and lower hospital-related cost of care.
authors.affiliation: The Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA. rbristo1@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D055815:Young Adult