An association between high hospital procedure volume and survival, following colon cancer resection, has previously been identified.
However, the importance of surgeon case volume as a determinant of outcome has been less well studied.
|Hospital and surgeon volume are both predictors of the ostomy rate.|
|Journal of Surgical Oncology|
It is unclear whether hospital or surgeon volume is the more powerful predictor of outcomes.
In this study, researchers from New York, USA, identified 24,166 colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
Patients were aged 65 years and older, and had surgery for a primary tumor diagnosed between 1991 and 1996.
The team determined hospital and surgeon-specific procedure volume from the number of claims submitted over the 6-year study period.
The outcome measures were mortality at 30 days and 2 years, overall survival, and the frequency of operations requiring an intestinal stoma.
The research team adjusted for age, sex, race, co-morbid illness, cancer stage, socioeconomic status, emergent hospitalization, and the presence of obstruction/perforation.
The team found that high hospital procedure volume remained a strong predictor of low post-operative mortality rates, once surgeon procedure volume was adjusted for.
They determined that surgeon-specific procedure volume was also an important predictor of outcome. However, this effect was attenuated after adjusting for hospital volume.
Hospital and surgeon volume were both important predictors of the ostomy rate.
Among high volume institutions and surgeons, individual providers with unusually high ostomy rates were able to be identified.
Dr Deborah Schrag’s team concluded, “Both hospital and surgeon-specific procedure volume predict outcomes following colon cancer resection; but hospital volume may exert a stronger effect”.
“Therefore, efforts to optimize the quality of colon cancer surgery should focus on multidisciplinary aspects of hospital care rather than solely on intraoperative technique”.