Quality Improvement in the Surgical Approach to Advanced Ovarian Cancer: The Mayo Clinic Experience

Giovanni D. Aletti, Sean C. Dowdy, Bobbie S. Gostout, Monica B. Jones, Robert C. Stanhope, Timothy O. Wilson, Karl C. Podratz, William A. Cliby

Research output: Contribution to journalArticle

72 Scopus citations

Abstract

Background: After observing disparate rates of cytoreduction, we initiated efforts to improve outcomes through feedback and education, and we reassessed outcomes. Study Design: Outcomes from group A (2006 and 2007, n = 105) were compared with those from the cohort predating quality-improvement efforts (group B, 2000 to 2003, n = 132). All stage IIIC ovarian cancer patients at our institution were evaluated for tumor dissemination, age, performance status, surgical complexity, residual disease (RD), morbidity, and mortality. A surgical complexity score previously described was used to categorize extent of operation. Results: No significant differences in age, performance status, or extent of disease were observed between cohorts. Surgical complexity increased after initiation of quality improvement (mean surgical complexity score, 5.5 to 7.1; p < 0.001), rates of optimal RD (< 1 cm) improved from 77% to 85% (p = 0.157), and rates of complete resection of all gross disease rose from 31% to 43% (p = 0.188). In the subset of patients with carcinomatosis most likely to benefit from extended surgical resection, radical procedures were used more frequently (63% versus 79%; p = 0.028), rates of optimal debulking (RD < 1 cm) increased (64% to 79%), and the rate of RD = 0 increased from 6% to 24% (p = 0.006). When disease was noted on the diaphragm, procedures to remove the disease were more frequently used (38% to 64%; p = 0.001). The rates of major perioperative morbidity (group B, 21% versus group A, 20%; p = 0.819) and 3-month mortality (8% versus 6%; p = 0.475) were not affected despite this more aggressive surgical approach. Conclusions: Analysis of outcomes with appropriate feedback and education is a powerful tool for quality improvement. We observed improvements in rates of cytoreduction and use of specific radical procedures, with no increase in morbidity as a result of this process.

Original languageEnglish (US)
Pages (from-to)614-620
Number of pages7
JournalJournal of the American College of Surgeons
Volume208
Issue number4
DOIs
StatePublished - Apr 1 2009

ASJC Scopus subject areas

  • Surgery

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