BACKGROUND: Greater hospital volume has been associated with lower mortality after colorectal cancer surgery. The contribution of surgeon volume to processes and outcomes of care is less well understood. We assessed the relation of surgeon and hospital volume to postoperative and overall mortality, colostomy rates, and use of adjuvant radiation therapy. METHODS: From the California Cancer Registry, we studied 28,644 patients who underwent surgical resection of stage I to III colorectal cancer during 1996 to 1999 and were followed up to 6 years after surgery to assess 30-day postoperative mortality, overall long-term mortality, permanent colostomy, and use of adjuvant radiation therapy. RESULTS: Across decreasing quartiles of hospital and surgeon volume, 30-day postoperative mortality ranged from 2.7% to 4.2% (P < 0.001). Adjusting for age, stage, comorbidity, and median income among patients with colorectal cancer who survived at least 30 days, patients in the lowest quartile of surgeon volume had a higher adjusted overall mortality rate than those in the highest quartile (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24), as did patients in the lowest quartile of hospital volume relative to those treated in the highest quartile (hazard ratio, 1.11; 95% confidence interval, 1.05-1.19). For rectal cancer, adjusted colostomy rates were significantly higher for low-volume surgeons, and the use of adjuvant radiation therapy was significantly lower for low-volume hospitals. CONCLUSIONS: Greater surgeon and hospital volumes were associated with improved outcomes for patients undergoing surgery for colorectal cancer. Further study of processes that led to these differences may improve the quality of colorectal cancer care.
BACKGROUND: Greater hospital volume has been associated with lower mortality after colorectal cancer surgery. The contribution of surgeon volume to processes and outcomes of care is less well understood. We assessed the relation of surgeon and hospital volume to postoperative and overall mortality, colostomy rates, and use of adjuvant radiation therapy. METHODS: From the California Cancer Registry, we studied 28,644 patients who underwent surgical resection of stage I to III colorectal cancer during 1996 to 1999 and were followed up to 6 years after surgery to assess 30-day postoperative mortality, overall long-term mortality, permanent colostomy, and use of adjuvant radiation therapy. RESULTS: Across decreasing quartiles of hospital and surgeon volume, 30-day postoperative mortality ranged from 2.7% to 4.2% (P < 0.001). Adjusting for age, stage, comorbidity, and median income among patients with colorectal cancer who survived at least 30 days, patients in the lowest quartile of surgeon volume had a higher adjusted overall mortality rate than those in the highest quartile (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24), as did patients in the lowest quartile of hospital volume relative to those treated in the highest quartile (hazard ratio, 1.11; 95% confidence interval, 1.05-1.19). For rectal cancer, adjusted colostomy rates were significantly higher for low-volume surgeons, and the use of adjuvant radiation therapy was significantly lower for low-volume hospitals. CONCLUSIONS: Greater surgeon and hospital volumes were associated with improved outcomes for patients undergoing surgery for colorectal cancer. Further study of processes that led to these differences may improve the quality of colorectal cancer care.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: M Simunovic; T To; N Baxter; A Balshem; E Ross; Z Cohen; R McLeod; P Engstrom; E Sigurdson Journal: J Gastrointest Surg Date: 2000 May-Jun Impact factor: 3.452
Authors: Karl Y Bilimoria; David J Bentrem; Andrew K Stewart; Mark S Talamonti; David P Winchester; Thomas R Russell; Clifford Y Ko Journal: J Natl Cancer Inst Date: 2008-09-09 Impact factor: 13.506
Authors: Rachelle N Damle; Christopher W Macomber; Julie M Flahive; Jennifer S Davids; W Brian Sweeney; Paul R Sturrock; Justin A Maykel; Heena P Santry; Karim Alavi Journal: J Am Coll Surg Date: 2014-03-12 Impact factor: 6.113
Authors: Sebastien Drolet; Anthony R MacLean; Robert P Myers; Abdel Aziz M Shaheen; Elijah Dixon; W Donald Buie Journal: J Gastrointest Surg Date: 2011-01-29 Impact factor: 3.452
Authors: Dorina Kallogjeri; Sheila M Gaynor; Marilyn L Piccirillo; Raymond A Jean; Edward L Spitznagel; Jay F Piccirillo Journal: J Am Coll Surg Date: 2014-03-19 Impact factor: 6.113
Authors: Jeong-Heum Baek; Abdulhadi Alrubaie; Eduardo A Guzman; Sun Keun Choi; Casandra Anderson; Steven Mills; Joseph Carmichael; Andy Dagis; Dajun Qian; Joseph Kim; Julio Garcia-Aguilar; Michael J Stamos; Lisa Bening; Alessio Pigazzi Journal: Int J Colorectal Dis Date: 2012-07-29 Impact factor: 2.571
Authors: Shira H Fischer; Jennifer Tjia; George Reed; Daniel Peterson; Jerry H Gurwitz; Terry S Field Journal: J Gen Intern Med Date: 2014-06-26 Impact factor: 5.128