Elective Resection of Colon Cancer by High-Volume Surgeons Is Associated with Decreased Morbidity and Mortality
The purpose of this study was to determine whether morbidity and mortality in patients undergoing elective resection of colon cancer are associated with surgeon or hospital volume.
Using the Nationwide Inpatient Sample database, we identified all adult patients who underwent elective resection for colon cancer as their primary procedure between 2003 and 2007. Cases were divided into three groups according to the mean number of resections performed annually by each surgeon: low volume (≤4/year), intermediate volume (5–9/year), or high volume (≥10/year). Annual hospital case-load was also categorized as low volume (≤30/year), intermediate volume (31–60/year), and high volume (≥61/year). Multiple logistic regression models were used to identify differences in morbidity and mortality.
A total of 54,000 patients underwent resection of colon cancer by 7,313 surgeons in 1,398 hospitals. After adjusting for important covariates including hospital volume, colon cancer resection by high-volume surgeons was an independent predictor of decreased morbidity (odds ratio [OR], 0.91; 95% CI, 0.85–0.97) and mortality (OR, 0.75; 95% CI, 0.65–0.86). Mortality was lowest among patients operated on by high-volume surgeons in high-volume hospitals (2.2% vs. 3.9%; OR, 0.56; 95% CI, 0.46–0.68).
In patients undergoing elective resection of colon cancer, procedures done by high-volume surgeons are associated with decreased morbidity and mortality.
KeywordsColon cancer Hospital volume Surgeon volume
- 1.Estimated new cancer cases and death by sex, US [National Cancer Institute] 2009. Available at: http://www.cancer.org/downloads/stt/CFF2009_EstCD_3.pdf. Accessed January 23, 2010
- 14.Nationwide Inpatient Sample, 2007 [Healthcare Cost and Utilization Project (HCUP) web site]. Available at: www.hcup-us.ahrq.gov/databases.jsp. Accessed November 15, 2009
- 15.Whalen D, Houchens R, Elixhauser A. 2004 HCUP nationwide inpatient sample (NIS) comparison report. HCUP method series report [Healthcare Cost and Utilization Project (HCUP) web site]. Available at: http://www.hcup-us.ahrq.gov/reports/methods.jsp. Accessed March 15, 2007.
- 16.Practice Management Information Corporation, International classification of diseases, 9th revision, clinical modification (ICD-9-CM). 6th ed, Practice Mgmt Information Corp; 2002.Google Scholar
- 18.US Department of Labor: Bureau of Labor Statistics. Consumer price index—all urban consumers (US Medical Care 1982–1984=100). Available at: http://www.bls.gov/cpi/home.htm.
- 20.Houchens R EA. Final report on calculating Nationwide Inpatient Sample (NIS) variances, 2001. HCUP Methods Series Report #2003-2, US Agency for Healthcare Research and Quality. 2006. Available at: http://www.hcup-us.ahrq.gov/reports/2003_2.jsp. Accessed 10/28, 2009.
- 26.Billingsley KG, Morris AM, Dominitz JA, Matthews B, Dobie S, Barlow W, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23–31; discussion 32.PubMedCrossRefGoogle Scholar