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.
Dr Alan Zaslavsky and colleagues assessed the relation of surgeon and hospital volume to mortality, colostomy rates, and use of adjuvant radiation therapy.
From the California Cancer Registry, the team of researchers studied 28,644 patients who underwent surgical resection of stage I to III colorectal cancer.
The patients underwent surgery during 1996 to 1999 and were followed up to 6 years after surgery to assess 30-day postoperative mortality.
|30-day postoperative mortality ranged from 3% to 4%|
|Annals of Surgery|
The researchers also assessed overall long-term mortality, permanent colostomy, and use of adjuvant radiation therapy.
Across decreasing quartiles of hospital and surgeon volume, 30-day postoperative mortality ranged from 3% to 4%.
The research team adjusted for age, stage, comorbidity, and median income among patients with colorectal cancer who survived at least 30 days.
The team found that patients in the lowest quartile of surgeon volume had a higher adjusted overall mortality rate than those in the highest quartile.
Patients in the lowest quartile of hospital volume relative to those treated in the highest quartile also had higher adjusted overall mortality rates.
For rectal cancer, the team observed that adjusted colostomy rates were significantly higher for low-volume surgeons.
In addition, the team noted that the use of adjuvant radiation therapy was significantly lower for low-volume hospitals.
Dr Zaslavsky's team concludes, “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.”