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Potential Consequences of Minimum-Volume Standards for Hospitals Treating Women With Ovarian Cancer

Wright, Jason D. MD; Huang, Yongmei MD, MPH; Melamed, Alexander MD, MPH; Tergas, Ana I. MD, MPH; St. Clair, Caryn M. MD; Hou, June Y. MD; Khoury-Collado, Fady MD; Ananth, Cande V. PhD, MPH; Neugut, Alfred I. MD, PhD; Hershman, Dawn L. MD

doi: 10.1097/AOG.0000000000003288
Contents: Gynecologic Oncology: Original Research
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OBJECTIVE: To assess the potential effects of implementing minimum hospital volume standards for ovarian cancer on survival and access to care.

METHODS: We used the National Cancer Database to identify hospitals treating women with ovarian cancer from 2005 to 2015. We estimated the number of patients treated by each hospital during the prior year. Multivariable models were used to estimate the ratio of observed/expected 60-day, and 1-, 2- and 5-year mortalities. The mean predicted observed/expected ratio of hospitals was plotted based on prior year volume. The number of hospitals that would be restricted if minimum-volume standards were implemented was modeled.

RESULTS: A total of 136,196 patients treated at 1,321 hospitals were identified. Increasing hospital volume was associated with decreased 60-day (P=.004), 1-year (P<.001), 2-year (P<.001) and 5-year (P=.008) mortality. In 2015, using a minimum-volume cutpoint of one case in the prior year would eliminate 144 (13.6%) hospitals (treated 2.6% of all patients); a cutpoint of three would eliminate 364 (34.5%) hospitals (treated 7.7% of the patients). The mean observed/expected ratios for hospitals with a prior year volume of 1 was 1.14 for 60-day mortality, 1.06 for 1-year mortality, 1.12 for 2-year mortality, and 1.08 for 5-year mortality. Among hospitals with a prior year volume of one, 49.2% had an observed/expected ratio for 2-year mortality of at least 1 (indicating worse than expected performance), and 50.8% had an observed/expected ratio of less than 1 (indicating better than expected performance). The mean observed/expected ratios for hospitals with a prior year volume of two or less were 1.11 for 60-day mortality, 1.09 for 1-year mortality, 1.08 for 2-year mortality, and 1.07 for 5-year mortality. 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.

CONCLUSION: Implementation of minimum hospital volume standards could restrict care at a significant number of hospitals, including many centers with better-than-predicted outcomes.

Implementation of minimum hospital-level volume standards could restrict care at a significant number of hospitals, including many centers with better-than-predicted outcomes.

Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, and the Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, New York, New York; Massachusetts General Hospital, Boston, Massachusetts; and Rutgers Robert Wood Johnson Medical School; and the Environmental and Occupational Health Sciences Institute (EOHSI), Piscataway, New Jersey.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032; email: jw2459@columbia.edu.

Dr. Wright (NCI R01CA169121-01A1) is the recipient of a grant from the National Cancer Institute. Dr. Hershman is the recipient of a grant from the Breast Cancer Research Foundation-Conquer Cancer Foundation.

Financial Disclosure Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. Dr. Neugut has served as a consultant to Pfizer, Teva, Otsuka, Hospira, and United Biosource Corporation. He is on the scientific advisory board of EHE, Intl. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at http://links.lww.com/AOG/B383.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.