Volume-outcome analysis of colorectal cancer-related outcomes

Abstract

Background: Significant associations between caseload and surgical outcomes highlight the conflict between local cancer care and the need for centralization. This study examined the effect of hospital volume on short-term outcomes and survival, adjusting for the effect of surgeon caseload. Methods: Between 1998 and 2002, 8219 patients with colorectal cancer were identified in a regional population-based audit. Outcomes were assessed using univariable and multivariable analysis to allow case mix adjustment. Surgeons were categorized as low (26 or fewer operations annually), medium (27-40) or high (more than 40) volume. Hospitals were categorized as low (86 or fewer), medium (87-109) or high (more than 109) volume. Results: Some 7411 (90-2 per cent) of 8219 patients underwent surgery with an anastomotic leak rate of 2-9 per cent (162 of 5581), perioperative mortality rate of 8-0 per cent (591 of 7411) and S-year survival rate of 46-8 per cent. Medium- and high-volume surgeons were associated with significantly better operative mortality (odds ratio (OR) 0-74, P = 0-010 and OR 0-66, P = 0.002 respectively) and survival (hazard ratio (HR) 0-88, P = 0-003 and HR 0-93, P = 0-090 respectively) than low-volume surgeons. Rectal cancer survival was significantly better in high-volume versus low-volume hospitals (HR 0-85, P = 0.036), with no difference between medium- and low-volume hospitals (HR 0.96, P = 0-505). Conclusion: This study has confirmed the relevance of minimum volume standards for individual surgeons. Organization of services in high-volume units may improve survival in patients with rectal cancer. Copyright © 2010 British Journal of Surgery Society Ltd.