(ChemotherapyAdvisor) – Patients with ovarian cancer treated at high-volume hospitals have lower mortality primarily because the hospitals have the ability to rescue patients when complications arise, not because of lower complication rates, a study reported in the Journal of Clinical Oncology online October 1.
“After accounting for patient and hospital characteristics, women treated at low-volume hospitals who experienced a complication were 48% more likely (OR 1.48; 95% CI, 1.11–1.99) to die than patients with a complication at a high-volume hospital,” noted Jason D. Wright, MD, of Columbia University College of Physicians and Surgeons, New York, NY, and colleagues.
The investigators sought to determine the mechanisms that underlie the well-described association between high surgical volume and improved procedural outcomes by examining the role of complications, failure to rescue from complications, and mortality based on hospital volume for ovarian cancer.
They identified 36,624 women who underwent surgery for ovarian cancer from 1988 to 2009 using the Nationwide Inpatient Sample. “Hospitals were ranked on the basis of their procedure volume,” they noted; also determined was risk-adjusted mortality, major complication rate, and “failure to rescue” rate, defined as mortality in patients with a major complication.
Mortality rate for the cohort was 1.6%, they found. At low-volume hospitals, the major complication rate was 20.4%; at intermediate volume, 23.4%; and, at high-volume hospitals, 24.6% (P<0.001). However, the rate of failure to rescue was significantly higher at low-volume hospitals, 8.0%, vs high-volume hospitals, 4.9% (P<0.001).
“Our finding that failure to rescue after postoperative complications is a major source of mortality at low-volume hospitals suggests that targeted initiatives to improve the quality of care for patients with complications may improve outcomes,” they wrote.
“…at the most basic level, our findings highlight the importance of prevention of complications in the first place. Although the benefits of the most radical surgery outweigh the morbidity in many women, this is clearly not the case for all patients. In addition to an increased mortality risk, perioperative complications are associated with long-term medical sequelae and substantial cost; they may also result in delays or omission of chemotherapy,” the authors concluded.