Consequences of Restricting Hospital Choices for Ovarian Cancer Surgery
Posted: Thursday, August 22, 2019
A metric other than previous volume of similar surgeries may make more sense for granting hospitals permission to have ovarian cancer surgeries performed there, according to a modeling study published in Obstetrics & Gynecology. One conclusion reached by the authors, for instance, was that more than half of the hospitals in the United States that performed three or fewer surgeries in the previous year had lower—not higher—expected 2-year mortality rates.
Jason Wright, MD, of Columbia University Vagelos College of Physicians and Surgeons in New York, and colleagues noted that implementing minimum hospital volume standards could significantly restrict care, excluding many centers with better-than-predicted outcomes. Requiring that a hospital performed three or more surgeries in the prior year as a cutpoint, for instance, would eliminate 364 hospitals—34.5% of those that performed them in 2015—that treated 7.7% of the ovarian cancer surgical patients nationally that year.
In a press release, Dr. Wright said he acknowledged the surface rationale for minimum-volume standards for ovarian cancer surgeries, “large procedures that require experience and a very specialized skill set.” But, he continued, he and his team had concerns about how applying such standards “would affect access to care for women with ovarian cancer, especially in rural areas.”
The study results did reveal that overall, increasing hospital volume was associated with decreased 60-day (P = .004) as well as 1-year (P < .001), 2-year (P < .001), and 5-year (P = .008) mortality. According to the study authors, “Implementing a minimum-volume standard of one case in the prior year would result in one fewer death for every 198 patients at 60 days, for every 613 patients at 1 year, and for every 62 patients at 5 years.”
Disclosure: The study authors’ disclosure information may be found at journals.lww.com.