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abstract:
The Society of Obstetricians and Gynaecologists of Canada
Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery: A Population-Based Review Using a National Administrative Database
Objectives
In this
pan-Canadian study, we sought to elucidate the current state of surgical
care for primary ovarian cancers and factors influencing selected
short-term outcomes; these were in-hospital mortality (IHM), major
complications (MCs), failure-to-rescue (FTR), and hospital length of
stay (LOS).
Methods
We
created a population cohort using inpatient admission records from the
Canadian Institute of Health Information data set (2004–2012).
Multilevel logistic regression and flexible parametric survival
analyses, adjusted for hospital clustering effect, were conducted to
determine the effect of patient-specific factors (i.e., age,
comorbidities, and admission category); procedural complexity; and the
surgical volume and specialty of each care provider on the outcomes of
interest.
Results
A total
of 16 089 women underwent surgeries for primary ovarian cancer across
Canada. The crude rates of IHM (in-hospital mortality), MC (major
complications), and FTR (failure-to-rescue) were 0.89%, 5.7%, and 9.09%,
respectively, with a median LOS of four days (interquartile range 3 to
6). The majority of surgical procedures were performed by surgeons and
hospitals with annual surgical volumes of less than five such
procedures. Hospitals with higher surgical volumes were associated with
lower risk of IHM (OR 0.95) and FTR (OR 0.95) and a higher chance of earlier discharge (hazard ratio
[HR] 1.03). Surgeons with higher surgical volumes
were associated with lower odds of early discharge (HR 0.90) and a higher risk of MC (OR 1.12).
Compared with gynaecologic oncologists, general surgeons had a
significantly higher risk of IHM (OR 3.50) and MC
(OR 2.13) and lower odds of early discharge (HR
0.43).
Conclusion
Despite
limitations in the administrative data set, valuable information was
available for this pan-Canadian analysis. Our findings support
centralization of surgical procedures for women with ovarian cancer in
tertiary care centres with higher surgical volumes that are staffed by
in-house multidisciplinary care teams and specialist surgeons.
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