Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care

A. K. Sinno*, X. Li, R. E. Thompson, Edward James Tanner, K. L. Levinson, R. L. Stone, S. M. Temkin, A. N. Fader, D. S. Chi, K. Long Roche

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objectives To describe the US national trends and factors associated with cytoreductive surgical radicality in women with advanced ovarian cancer (OC). Methods 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. Results 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). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)493-499
Number of pages7
JournalGynecologic oncology
Volume145
Issue number3
DOIs
StatePublished - Jun 2017

Keywords

  • Centralized care
  • Cytoreductive surgery
  • Debulking
  • Disparities
  • Ovarian cancer
  • Upper abdominal procedures

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Sinno, A. K., Li, X., Thompson, R. E., Tanner, E. J., Levinson, K. L., Stone, R. L., Temkin, S. M., Fader, A. N., Chi, D. S., & Long Roche, K. (2017). Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care. Gynecologic oncology, 145(3), 493-499. https://doi.org/10.1016/j.ygyno.2017.03.020