Impact of hospital volume on surgical management and outcomes for early-stage cervical cancer.

OBJECTIVE

To determine whether process and outcome measures varied for patients with early-stage cervical cancer based on hospital surgical volume.

METHODS

Using the National Cancer Database, we identified women with stages IA2 - IB1 cervical cancer (2011-2013). Annual hospital volume was calculated using number of hysterectomies performed in the prior year and grouped into patient level-quartiles. Centers in the highest quartile of volume were defined as HVCs; those in the lowest quartile, as LVCs. Demographics, type/mode of hysterectomy, lymph node assessment, NCCN-compliant surgery (radical hysterectomy (RH) with LND), and survival outcomes were compared across quartiles of hospital volume. Cox Proportional Hazards model was performed to determine impact of volume on mortality.

RESULTS

We identified 3469 women treated at 598 different hospitals. RH was more likely at HVCs versus LVCs (68.9% vs. 59.6%, p < 0.001). LND was more likely at HVCs versus LVCs (96.1% vs 87.3%, p < 0.001). Patients treated at HVCs were 11.4% more likely to receive guideline-compliant surgery compared to LVCs (67.8% vs. 56.4%, p < 0.001). There was no difference in 5-year survival, 90-day survival, all-cause mortality across volume quartiles. Thirty-day mortality was significantly lower at HVCs (0 deaths in 880 patients) versus LVCs (1 in 1058 (0.1%, p = 0.02)). Age ≥ 80, Medicaid and Medicare insurance, Hispanic race, and poorly differentiated histology were independent predictors of mortality. Hospital volume was not found to be an independent predictor of mortality (p = 0.95).

CONCLUSIONS

HVCs demonstrated higher rates of NCCN-recommended surgery for early-stage cervical cancer. There was no association between hospital volume and survival.