Dr Kevin Billingsley and colleagues from Oregon, USA assessed the relationship between surgeon and hospital volume and major postoperative complications after rectal cancer surgery.
The research team defined other surgeon and hospital characteristics that may explain observed volume-complication relationships.
|Mid-career surgeons have the lowest rates of postoperative procedural interventions|
|Journal of the American College of Surgeons|
The team undertook a retrospective cohort design using data from the Surveillance, Epidemiology, and End Results Cancer registry program.
Individuals were diagnosed with stage 1 to 3 rectal cancer between 1992 and 1999, and were treated with resection.
The patients' Surveillance, Epidemiology, and End Results data were linked with Medicare claims data from 1991 to 2000.
The team's primary outcomes were 30-day postoperative procedural interventions to treat surgical complications, such as reoperation.
The association between surgeon volume and postoperative procedural interventions was examined using logistic regression modeling with adjustment for covariates.
The odds of a rectal cancer patient requiring a postoperative procedural interventions is notably less if the operation is performed by one of a small subset of very high volume surgeons.
The team noted that board certification in colorectal surgery did not alter the relationship between surgeon volume and postoperative procedural interventions.
However, the research team found that surgeon age did influence the relationship between surgeon volume and postoperative procedural interventions.
Mid-career surgeons having the lowest rates of postoperative procedural interventions, regardless of practice volume.
When adjusted for surgeon age, surgeon volume is no longer a marked predictor of complications.
Dr Billingsley's team concluded, "Overall, rectal cancer operations are safe, with a low frequency of severe complications."
"A subset of very high volume rectal surgeons performs these operations with fewer complications that require procedural intervention or reoperation."
"Surgeon age, as an indicator of experience, also contributes modestly to outcomes."
"These data do not justify regionalizing rectal cancer care based on safety concerns."