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Caring for Patients With Uterine Cancer in Rural and Public Hospitals in New York State

Gamble, Charlotte R. MD, MPH; Huang, Yongmei MD, MPH; Frey, Melissa K. MD; Wright, Jason D. MD

doi: 10.1097/AOG.0000000000003583
Contents: Gynecologic Oncology: Original Research
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OBJECTIVE: To evaluate perioperative outcomes for women with uterine cancer undergoing hysterectomy at rural and public hospitals in New York State.

METHODS: The New York Statewide Planning And Research Cooperative System database was used to identify women with uterine cancer who underwent hysterectomy from 2000 to 2015. Perioperative complications, inpatient mortality, and resource utilization were compared at rural, public and private hospitals. Multilevel mixed effect log-linear models were developed to evaluate the association between hospital type and outcomes of interest. Patient characteristics, hospital and surgeon clustering were accounted for within the model.

RESULTS: Over the years studied, there were 193 hospitals that cared for 46,298 women with uterine cancer. Of these, 9.8% were public, 15.0% were rural, and 75.1% were private metropolitan. They cared for 11.0%, 2.2% and 86.8% of patients, respectively. The proportion of patients cared for at rural hospitals decreased significantly from 5.2% in 2000 to 0.6% in 2014 (P<.001). There was no change in the volume of patients cared for at public hospitals (11.3 to 10.3%, P>.05). In a multivariable model adjusting for patient risk, there were no significant differences in perioperative morbidity, transfusion and length of stay across the three hospital types (P>.05). Compared with private hospitals, treatment at a rural hospital was associated with increased inpatient mortality (adjusted risk ratio 4.03, 95% CI 1.02–15.97).

CONCLUSION: In New York State, operative uterine cancer care is shifting away from rural hospitals. Public hospitals have similar risk-adjusted outcomes compared with private metropolitan facilities.

In New York State, fewer women with uterine cancer are receiving hysterectomies at rural hospitals. Public hospitals have similar risk-adjusted outcomes as private hospitals.

Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Weill Cornell Medical Center, the Joseph L. Mailman School of Public Health, Columbia University, and the Herbert Irving Comprehensive Cancer Center, New York, New York.

Corresponding author: Charlotte R. Gamble, MD, MPH, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; email: cg3096@cumc.columbia.edu.

Financial Disclosure Jason D. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented as a poster at the Society of Gynecologic Oncology’s 50th Annual Meeting on Women's Cancer, March 15–19, 2019, Honolulu, Hawaii.

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

Peer reviews are available at http://links.lww.com/AOG/B630.

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