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Gynecol Oncol. 2009 Mar;112(3):455-61. doi: 10.1016/j.ygyno.2008.11.011. Epub 2009 Jan 12.

Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands.

Author information

1
Department of Gynecological Surgery and Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. f.vernooij@umcutrecht.nl

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.

CONCLUSION:

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.

PMID:
19136148
DOI:
10.1016/j.ygyno.2008.11.011
[Indexed for MEDLINE]

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