TY - JOUR
T1 - Effect of surgical volume on short-term outcomes of cytoreductive surgery for advanced-stage ovarian cancer
T2 - A population-based study from the Dutch Gynecological Oncology Audit
AU - The Dutch Gynecological Oncology Audit Collaborator Group
AU - Algera, M. D.
AU - van Driel, W. J.
AU - Slangen, B. F.M.
AU - Wouters, M. W.J.M.
AU - Kruitwagen, R. F.P.M.
AU - Kruse, A. J.
AU - Yigit, R.
AU - Engelen, M. J.A.
AU - Nooij, L. S.
AU - Mens, J. W.M.
AU - de Jong, M. A.A.
AU - Haverkort, M. A.D.
AU - van der Aa, M.
AU - Diepstraten, J.
AU - van Ham, M. A.P.C.
AU - Smedts, H. P.M.
AU - Reesink, N.
AU - Gaarenstroom, K. N.
AU - Vencken, P. M.L.H.
AU - Boll, D.
AU - Fons, G.
AU - Baalbergen, A.
AU - van Dorst, E. B.L.
AU - Roes, E. M.
AU - Nagel, H. T.C.
AU - van Ginkel, A.
AU - de Waard, J.
AU - Hofman, L. N.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/7
Y1 - 2024/7
N2 - Objective: Despite lacking clinical data, the Dutch government is considering increasing the minimum annual surgical volume per center from twenty to fifty cytoreductive surgeries (CRS) for advanced-stage ovarian cancer (OC). This study aims to evaluate whether this increase is warranted. Methods: This population-based study included all CRS for FIGO-stage IIB-IVB OC registered in eighteen Dutch hospitals between 2019 and 2022. Short-term outcomes included result of CRS, length of stay, severe complications, 30-day mortality, time to adjuvant chemotherapy, and textbook outcome. Patients were stratified by annual volume: low-volume (nine hospitals, <25), medium-volume (four hospitals, 29–37), and high-volume (five hospitals, 54–84). Descriptive statistics and multilevel logistic regressions were used to assess the (case-mix adjusted) associations of surgical volume and outcomes. Results: A total of 1646 interval CRS (iCRS) and 789 primary CRS (pCRS) were included. No associations were found between surgical volume and different outcomes in the iCRS cohort. In the pCRS cohort, high-volume was associated with increased complete CRS rates (aOR 1.9, 95%-CI 1.2–3.1, p = 0.010). Furthermore, high-volume was associated with increased severe complication rates (aOR 2.3, 1.1–4.6, 95%-CI 1.3–4.2, p = 0.022) and prolonged length of stay (aOR 2.3, 95%-CI 1.3–4.2, p = 0.005). 30-day mortality, time to adjuvant chemotherapy, and textbook outcome were not associated with surgical volume in the pCRS cohort. Subgroup analyses (FIGO-stage IIIC-IVB) showed similar results. Various case-mix factors significantly impacted outcomes, warranting case-mix adjustment. Conclusions: Our analyses do not support further centralization of iCRS for advanced-stage OC. High-volume was associated with higher complete pCRS, suggesting either a more accurate selection in these hospitals or a more aggressive approach. The higher completeness rates were at the expense of higher severe complications and prolonged admissions.
AB - Objective: Despite lacking clinical data, the Dutch government is considering increasing the minimum annual surgical volume per center from twenty to fifty cytoreductive surgeries (CRS) for advanced-stage ovarian cancer (OC). This study aims to evaluate whether this increase is warranted. Methods: This population-based study included all CRS for FIGO-stage IIB-IVB OC registered in eighteen Dutch hospitals between 2019 and 2022. Short-term outcomes included result of CRS, length of stay, severe complications, 30-day mortality, time to adjuvant chemotherapy, and textbook outcome. Patients were stratified by annual volume: low-volume (nine hospitals, <25), medium-volume (four hospitals, 29–37), and high-volume (five hospitals, 54–84). Descriptive statistics and multilevel logistic regressions were used to assess the (case-mix adjusted) associations of surgical volume and outcomes. Results: A total of 1646 interval CRS (iCRS) and 789 primary CRS (pCRS) were included. No associations were found between surgical volume and different outcomes in the iCRS cohort. In the pCRS cohort, high-volume was associated with increased complete CRS rates (aOR 1.9, 95%-CI 1.2–3.1, p = 0.010). Furthermore, high-volume was associated with increased severe complication rates (aOR 2.3, 1.1–4.6, 95%-CI 1.3–4.2, p = 0.022) and prolonged length of stay (aOR 2.3, 95%-CI 1.3–4.2, p = 0.005). 30-day mortality, time to adjuvant chemotherapy, and textbook outcome were not associated with surgical volume in the pCRS cohort. Subgroup analyses (FIGO-stage IIIC-IVB) showed similar results. Various case-mix factors significantly impacted outcomes, warranting case-mix adjustment. Conclusions: Our analyses do not support further centralization of iCRS for advanced-stage OC. High-volume was associated with higher complete pCRS, suggesting either a more accurate selection in these hospitals or a more aggressive approach. The higher completeness rates were at the expense of higher severe complications and prolonged admissions.
KW - Advanced-stage ovarian cancer
KW - Clinical auditing
KW - Complete cytoreduction
KW - Cytoreductive surgery
KW - Length of stay
KW - Mortality
KW - Postoperative complications
KW - Surgical volume
KW - Textbook outcome
UR - http://www.scopus.com/inward/record.url?scp=85191415847&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2024.04.002
DO - 10.1016/j.ygyno.2024.04.002
M3 - Article
C2 - 38688188
AN - SCOPUS:85191415847
SN - 0090-8258
VL - 186
SP - 144
EP - 153
JO - Gynecologic Oncology
JF - Gynecologic Oncology
ER -