PURPOSE:

• When assessing ovarian cancer survival, both hospital and physician procedural volume are associated with improved outcomes
• Following recommended guidelines is also associated with improved outcomes
• The purpose of this study by Wright et al. (Obstetrics & Gynecology, 2017) was to determine the relative importance of hospital volume compared to complying with standards and guidelines

METHODS:

• Retrospective cohort study using the National Cancer Database
• Invasive epithelial ovarian cancer diagnosed from 2004 to 2013
• Annualized hospital volume based total number of patients divided by the years in which a given hospital treated at least one patient
• Volume definitions (annual)
  • High-volume hospital: 20 cases or greater
  • High- to intermediate-volume hospital: 9.01–19.9 cases
  • Intermediate-volume hospital: 5.01–9 cases
  • Intermediate-low hospital: 2.01–5 cases
  • Low-volume hospital: ≤ 2 cases
• Primary outcome of the analysis was overall survival at 2 and 5 years

RESULTS:

• 100,725 patients treated at 1,268 hospitals were identified
• Compliance with the composite, overall quality metric was noted in 64.2% (SD 24.5%) of low-volume centers and increased with each volume category to 82.2% (SD 7.7%) at the highest volume hospitals
• Two-year adjusted survival rose sequentially from 64.4% (95% CI 62.5–66.4%) at low-volume hospitals to 77.4% (95% CI 77.0–77.8%) at high-volume hospitals (P<.001)
• Two-year adjusted survival rose sequentially from 66.5% (95% CI 65.5–67.5%) at low-quality hospitals to 77.3% (95% CI 76.8–77.7%) at high-quality hospitals (P<.001)
• Similar findings (survival increased with volume and adherence to standards) were observed for 5-year rates
• When controlling for each hospital volume category, survival increased with increasing quality
  • Adjusted 2-year survival was 61.4% (95% CI 58.4–64.5%) at hospitals with the lowest adherence to quality metrics and rose to 65.8% (95% CI 61.2–70.8%) at the hospitals with highest adherence to the quality metrics (P<.001)
  • Lower volume hospitals with higher quality scores still had survival that was lower than higher volume hospitals

CONCLUSION:

• Best outcomes were still seen at high-volume hospitals and therefore referral to these centers for ovarian cancer care is reasonable
• However, for practical reasons, low-volume hospitals may still serve an important role and targeting quality improvement and adherence to standards may improve outcomes

Learn More – Primary Sources:

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

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