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Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care.
Sinno, A K; Li, X; Thompson, R E; Tanner, E J; Levinson, K L; Stone, R L; Temkin, S M; Fader, A N; Chi, D S; Long Roche, K.
Afiliación
  • Sinno AK; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center, USA. Electronic address: asinno@dhs.lacounty.gov.
  • Li X; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Thompson RE; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Tanner EJ; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Levinson KL; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Stone RL; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Temkin SM; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Fader AN; Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Chi DS; Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Long Roche K; Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol ; 145(3): 493-499, 2017 06.
Article en En | MEDLINE | ID: mdl-28366546
OBJECTIVES: To describe the US national trends and factors associated with cytoreductive surgical radicality in women with advanced ovarian cancer (OC). METHODS: An analysis of the National Inpatient Sample database was performed. All admissions from 1993 to 2011 for advanced OC cytoreductive surgery (CRS) were identified and categorized as simple pelvic (SP), extensive pelvic (EP), and extensive upper abdominal (EUA) surgery. Annual trends in CRS were analyzed. Associations between patient- and hospital-specific factors, with CRS radicality as well as perioperative complications were explored between 2007 and 2011. RESULTS: In total, 28,677 un-weighted admissions were analyzed. The rate of EP and EUA resections increased over time (8% to 18.1% and 1.3% to 5.4%, P<0.01, respectively). On multivariate analysis, patients were more likely to undergo EUA resections in the Northeast (OR 1.44) or West Coast (OR 1.47) at urban (OR 2.3), or large hospitals (OR 1.4), or if they had private insurance (OR 1.45). EUA surgeries were performed more frequently at high-volume ovarian cancer centers (OR 2.65); additionally, fewer complications were observed after EUA at high compared with low and medium volume hospitals (10.2%, 21.2%, and 21.7%, respectively; P=0.01). Specifically, patients treated at high volume hospitals experienced lower rates of hemorrhage, vascular/nerve injury, prolonged hospitalization, and non-routine discharge than at lower (P<0.05). CONCLUSIONS: The US rate of radical cytoreductive surgery for advanced ovarian cancer is increasing. At high-volume hospitals, patients receive more radical surgery with fewer complications, supporting further study of a centralized ovarian cancer care model.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Ováricas / Procedimientos Quirúrgicos Ginecológicos / Neoplasias Glandulares y Epiteliales Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Gynecol Oncol Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Ováricas / Procedimientos Quirúrgicos Ginecológicos / Neoplasias Glandulares y Epiteliales Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Gynecol Oncol Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos