Surgical care of young women diagnosed with ovarian cancer: a population-based perspective

Abstract

Objective: To characterize primary surgical care for women with ovarian cancer aged </=50 years versus > 50 years.

Methods: A statewide hospital discharge database was used to identify women undergoing primary surgery for ovarian cancer from 1990 to 2000. Logistic regression models were used to evaluate differences in demographic characteristics and short-term outcomes comparing women </=50 years versus >50 years.

Results: Women </=50 years comprised 30.2% (n=731) of 2417 identified cases. The 30-day mortality rate was 54% lower among women </=50 years (1.2% vs. 2.6%, P=0.0100). Women </=50 years were less likely to be managed by high-volume surgeons versus women >50 years (47.1% vs. 59.5%, P<0.0001). Younger women managed by high-volume surgeons had longer lengths of stay (5.7 days vs. 7.7 days, P<0.0001), longer ICU stays (0.2 days vs. 0.5 days, P=0.0020), more billed procedures (4.2 vs. 5.5, P<0.0001), higher adjusted cost of hospital-related care ($46,590 vs. $97,538, P<0.0001) and more comorbidities (1.0 vs. 1.6, P<0.0001) than those treated by lower-volume surgeons. Women </=50 years were as likely to be managed at high volume centers as low volume centers (57.7% vs. 61.3% P=0.0968). A similar trend in outcomes was observed in younger women treated at high-versus low-volume hospitals as high-versus low-volume surgeons.

Conclusion: Primary surgical care for ovarian cancer in women </=50 years is often performed by low-volume providers at low-volume centers. In light of positive volume-outcome data for malignancies treated with complex operative procedures, further efforts to characterize the surgical care of young women with ovarian cancer are warranted.