Uterine cancer in Maryland: Impact of surgeon case volume and other prognostic factors on short-term mortality

Objectives.To characterize the patterns of primary surgical care and short term outcomes for uterine cancer according to surgeon and hospital case volume.Methods.A statewide hospital discharge database was used to identify women undergoing primary surgery for uterine cancer during 1994–2005. Surgeon case volume was categorized as low (≤ 99 cases/12 years), or high (≥ 100 cases/12 years). Hospital case volume was categorized as low (≤ 199 cases/12 years), or high (≥ 200 cases/12 years). Logistic regression models were used to evaluate for significant factors associated with in-hospital death and access to high volume care.Results.Overall, 6,181 cases for uterine cancer were performed by 894 surgeons at 49 hospitals. Low volume surgeons performed 62.4% of the cases. Management by high volume surgeons was associated with a 53% reduction in the risk of the case being managed by different attending physician/surgeon (95%CI 0.38–0.57, p < 0.00). In contrast, 90.5% of cases were performed at high volume hospitals. Management by different attending physician/surgeon was associated with a 2.6 increase in the risk of in hospital death (95%CI 1.41–4.79, p = 0.00). Surgery performed by high-volume surgeons was associated with a 48% reduction in the risk of in-hospital death (95%CI 0.26–1.00, p = 0.05).Conclusions.Surgical management of uterine cancer by high volume surgeons is associated with a decrease risk in in-hospital death. Increased efforts to concentrate the surgical management of uterine cancer by high volume surgeons at high volume centers should be undertaken.