Effect of surgeon specialty on outcomes for ovarian cancer

Abstract

6027 Background: Specialized care has been associated with superior quality care for many diseases, but has not been previously examined for ovarian cancer surgery. Methods: We analyzed the Medicare claims of all patients undergoing surgery for ovarian cancer diagnosed while living in areas monitored by the Surveillance, Epidemiology, and End Results (SEER) program between 1992–1999. Claims were linked to American Medical Association files to determine provider type. Results: Among 3,067 patients who underwent surgery, gynecologic oncologists (GO) operated on 31% of patients, gynecologists (G) 41%, and non-specialist surgeons (S) the remaining 28%. Rates of specialized care increased over the study period from 25% to 37% (P<.0001), and varied geographically with more patients in the Northeast and South having GO than those in the Midwest and West (P<.0001). Other factors associated with being operated on by a gynecologic specialist on both univariate and multivariate analyses were: younger age (Odds Ratio (OR) .97, 95% Confidence Interval (CI) .96-.99) for each increasing year, black race (OR 1.73, 1.2–2.5), and more advanced (stage III/IV) disease (OR 1.48, 1.2–1.81). Compared to S, patients of GO were less likely to require multiple surgeries in the peri-diagnostic period (3% vs 5%, P=.05). Patients with stage III or IV disease managed by GO were more likely to undergo a debulking procedure or have a lymph node dissection (64% vs. 27%, P<.0001) at the time of their first surgery, less likely to require an ostomy (18% vs. 25%, P<.0001), and less likely to undergo second-look laparotomies (14% vs. 18%, P<.0001). They were also more likely to receive chemotherapy in the subsequent 12 months (79% vs 68%, P<.0001). There were no clear differences in rehospitalization or complication rates. Cox modeling suggested an adjusted hazard ratio of 0.89 (CI .80-.98) for patients receiving specialized care. Conclusions: Initial management of advanced ovarian cancer by specialist surgeons may be associated with better quality of care and outcomes. No significant financial relationships to disclose.