title: Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care.
abstract: To describe the US national trends and factors associated with cytoreductive surgical radicality in women with advanced ovarian cancer (OC).
  
  
  
  An analysis of the National Inpatient Sample database was performed. All admissions from 1993 to 2011 for advanced OC cytoreductive surgery (CRS) were identified and categorized as simple pelvic (SP), extensive pelvic (EP), and extensive upper abdominal (EUA) surgery. Annual trends in CRS were analyzed. Associations between patient- and hospital-specific factors, with CRS radicality as well as perioperative complications were explored between 2007 and 2011.
  
  
  
  In total, 28,677 un-weighted admissions were analyzed. The rate of EP and EUA resections increased over time (8% to 18.1% and 1.3% to 5.4%, P<0.01, respectively). On multivariate analysis, patients were more likely to undergo EUA resections in the Northeast (OR 1.44) or West Coast (OR 1.47) at urban (OR 2.3), or large hospitals (OR 1.4), or if they had private insurance (OR 1.45). EUA surgeries were performed more frequently at high-volume ovarian cancer centers (OR 2.65); additionally, fewer complications were observed after EUA at high compared with low and medium volume hospitals (10.2%, 21.2%, and 21.7%, respectively; P=0.01). Specifically, patients treated at high volume hospitals experienced lower rates of hemorrhage, vascular/nerve injury, prolonged hospitalization, and non-routine discharge than at lower (P<0.05).
  
  
  
  The US rate of radical cytoreductive surgery for advanced ovarian cancer is increasing. At high-volume hospitals, patients receive more radical surgery with fewer complications, supporting further study of a centralized ovarian cancer care model.
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center, USA. Electronic address: asinno@dhs.lacounty.gov.
authors.forename: A K
authors.initials: AK
authors.lastname: Sinno
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Thompson
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Tanner
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Levinson
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Stone
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Temkin
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Fader
authors.affiliation: Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
authors.affiliation: Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: K
authors.initials: K
authors.lastname: Long Roche
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Centralized care; Cytoreductive surgery; Debulking; Disparities; Ovarian cancer; Upper abdominal procedures