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5.2 QI 2 - Number of cytoreductive surgeries performed per center and per surgeon
per year
5.2.1 Description of the QI
TYPE Structural indicator number of upfront or interval cytoreductive surgeries performed per
center.
Process indicator number of surgeries per surgeon per year.
DESCRIPTION Only surgeries with an initial objective of complete cytoreduction are recorded.
Exploratory endoscopies, exploratory laparotomies, or surgeries limited to tissue biopsy
that do not include at least a bilateral salpingo-oophorectomy if applica ble,
hysterectomy if applicable, and a comprehensive peritoneal staging including
omentectomy are not included.
SPECIFICATIONS Numerator: i) number of cytoreductive surgeries as defined above performed per center
per year. ii) number of cytoreductive surgeries as defined above performed per surgeon
per year. Secondary and tertiary procedures are accepted.
Denominator: not applicable.
TARGETS i) Number of surgeries performed per center per year:
Optimal target: N ≥ 100.
Intermediate target: N ≥ 50.
Minimum required target: N ≥ 20
ii) ≥ 95% of surgeries are performed or supervised by surgeons operating at least 10
patients a year.
SCORING RULE i) 5 if the optimal target is met, 3 if the intermediate target is met, 1 if the minimum
required target is met.
ii) 3 if the target is met.
5.2.2 Rationale
Although hospital volume and surgeon volume are not a sufficient guarantee of surgical quality, they are a major
prerequisite. Patients treated in high volume hospitals have a higher chance of receiving standard treatment
surgery conformed to recommended guidelines compared to patients treated in low volume hospitals 207. The
postoperative hospital stay is correlated with the number of surgical procedures done208. So, the hospital volume
and surgeon volume must have to merged with outcome e.g. complete surgical resection and complications
which must also be recorded. One previous initiative26 published a QI for this topic.
5.2.3 Summary of available scientific evidence LoE 2-
Impact of hospital volume on survival: du Bois et al.209 performed a systematic review of the
literature to evaluate notably whether hospital volume has any impact on outcome in ovarian cancer
patients. The authors included 6 studies112,210-214. Hospital volume showed a significant impact on
survival in multivariate analyses in 3 studies after adjustment for 1 age, stage, histological
confirmation, year of diagnosis212, 2 adjustment for age, stage, type of operation, period of
operation213, or 3 after adjustment for age, stage, histology 214. In o ne of these studies, the only
high-volume center was also the only center where a gynecologic oncologist was present in that
region212. One out of the 6 studies included in the systematic review published by du Bois et al.209
reported an association between volume and survival univariate analysis, but this association was
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