Minimally invasive surgery for early-stage ovarian cancer: Association between hospital surgical volume and short-term perioperative outcomes

Abstract

ObjectiveTo examine trends and associated characteristics and outcomes of minimally invasive surgery (MIS) for women with early-stage ovarian cancer. MethodsThe National Inpatient Sample was queried to examine early-stage ovarian cancer treated with MIS from 2001 to 2011. Annualized hospital surgical volume was defined in the unweighted model as the average number of procedures performed per year in which at least one case was performed. Trends, characteristics, and outcomes related to MIS use were assessed in the weighted model. ResultsAmong 73,707 oophorectomy cases, there were 4822 (6.5%) MIS cases. Utilization of MIS increased from 3.9% to 13.5% from 2001 to 2011 (3.5-fold increase, P < 0.001), and the number of MIS-offering centers also increased from 10.6% to 36.2% (3.4-fold increase, P < 0.001). MIS was associated with a decreased complication rate (20.3% versus 35.4%) and shorter hospital stay (median, 2 versus 4 days) compared to laparotomy (both, P < 0.001). Of the 472 hospitals at which MIS was performed, the majority were minimum-volume with one MIS oophorectomy per year (340 [72.0%], n = 1929 [40.0%]), followed by mid-volume (85 [18.0%], n = 1272 [26.4%]) and topdecile-volume (47 [10.0%] hospitals, n = 1621 [33.6%]). The topdecile-volume group had the highest rate of lymphadenectomy compared to other groups (62.2% versus 39.2–55.1%, P < 0.05). On multivariable analysis, a one increment increase in annualized hospital surgical volume was associated with an 11% decrease in multiple complications (adjusted-odds ratio 0.89, 95% confidence interval 0.82–0.97, P = 0.006). ConclusionUtilization of MIS for early-stage ovarian cancer has significantly increased in the United States in 2000s. In 2011, one in eight surgeries performed for early ovarian cancer were performed via MIS. MIS procedures performed at hospitals with a higher surgical volume may be associated with improved short-term perioperative outcomes.