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 19 November 2017

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News

Impact of surgeon and hospital volume on colon cancer resection outcome

Surgeon and hospital volume, although statistically significant, do not influence the outcome after colon cancer resection as much as other factors, according to a study reported in the August issue of Surgery.

News image

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Researchers from California and Illinois, USA, evaluated whether high-volume surgeons and hospitals are the most important predictors of outcome for colon cancer.

Nationwide data from the Healthcare Cost and Utilization Program was obtained on all patients undergoing colon cancer resection (n = 22,408).

The associations between in-hospital mortality and more than 30 different independent variables were analyzed.

The variables looked at included demographic factors, burden of morbid and comorbid disease, and provider variables.

A separate analysis was then performed to compare the relative importance for all predictor variables.

Of the patients included in the study, 622 in-hospital deaths occurred (2.8%).

The average age was 70 years old, 51% of participants were male, and 60% had at least 1 comorbid disease.

Mortality probability:
Baseline: 1.2%
High-volume hospital: 1.1%
High-volume surgeon: 1.0%
Surgery
Operations were defined as elective (64%), urgent (19%), or emergency (15%).

The significant predictors for mortality included age, gender, comorbid disease, operation severity (i.e., emergency, urgent), and volume (both hospital and surgeon).

From the baseline probability analysis, the team found that the mortality for a baseline case was 1.2%.

They went on to discover that, if this baseline case went to a high-volume hospital or surgeon, the mortality would decrease to 1.1% and 1.0%, respectively.

If a patient with a baseline case of colon cancer also had coexistent liver disease or required an emergency operation, mortality increased to 4.4% and 4.5%, respectively.

Overall, the volume variables, although statistically significant, have a relatively smaller effect on outcome compared with other factors.

Dr Clifford Y. Ko, of the UCLA School of Medicine and Public Health, Los Angeles, California, concluded on behalf of his group, "The study elucidates and compares the relative importance of several different factors on outcome.

"This is essential when considering the conclusions and implications of this type of policy-relevant outcomes research."

Surgery 2002; 132: 268-73
11 September 2002

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