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Influence of surgeon specialty and volume on the utilization of minimally invasive surgery and outcomes for colorectal cancer: a retrospective review

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Abstract

Background

Utilization of minimally invasive surgery (MIS) has multiple determinants, one being the specialization of the surgeon. The purpose of this study was to assess the differences in the utilization of MIS, associated length of stay (LOS), and complications for colorectal cancer between colorectal (CRS) and general surgeons (GS). Previous studies have documented the influence of surgical volume and surgeon specialty on clinical outcomes and patient survival following colorectal cancer surgery. It is unclear whether there are differences in the utilization of MIS for colorectal cancer based on surgeon’s specialization and how this influences clinical outcomes.

Methods

Using the 2013–2015 Florida Inpatient Discharge Dataset and the National Plan & Provider Enumeration System, colorectal cancer patients experiencing a colorectal surgery were identified as well as the operating physician’s specialty. Mixed-effects regression models were used to identify associations between the use of MIS, complications during the hospital stay, and patient LOS with patient, physician, and hospital characteristics.

Results

There is no difference in the use of MIS, complication, nor LOS between GS and CRS for colorectal cancer surgery. However, physician volume was associated with increased use of MIS (OR 1.26, 95% CI 1.09, 1.46) and MIS was associated with decreases in certain complications as well as reductions in LOS overall (β = − 0.16, p < 0.001) and for each specialty (GS: β = − 0.18, p < 0.001; CRS β = − 0.12, p < 0.001)

Conclusions

Despite the higher amount of proctectomies performed by CRS, no difference in MIS utilization, complication rate, or LOS was found for colorectal cancer patients based on surgeon specialty. While there are some differences in clinical outcomes attributable to specialized training, results from this study indicate that differences in surgical approach (MIS vs. Open), as well as the patient populations encountered by these two specialties, are key factors in the outcomes observed.

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Funding

This work was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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Authors and Affiliations

  1. Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, USA

    Osayande Osagiede

  2. Urology Department, Mayo Clinic, Jacksonville, FL, USA

    Daniela A. Haehn

  3. Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Fl, 32224, USA

    Aaron C. Spaulding, Nolan Otto & Jordan J. Cochuyt

  4. Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Jacksonville, FL, USA

    Aaron C. Spaulding, Nolan Otto, Riccardo Lemini & Dorin T. Colibaseanu

  5. Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    Riccardo Lemini, Amit Merchea & Dorin T. Colibaseanu

  6. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Scott Kelley

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  1. Osayande Osagiede
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  2. Daniela A. Haehn
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  3. Aaron C. Spaulding
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  4. Nolan Otto
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  7. Amit Merchea
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  8. Scott Kelley
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  9. Dorin T. Colibaseanu
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Corresponding author

Correspondence to Aaron C. Spaulding.

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Disclosure

Drs. Osagiede, Haehn, Spaulding, Otto, Cochuyt, Lemini, Merchea, Kelly, and Colibaseanu have no conflict of interest or financial ties to disclose.

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Osagiede, O., Haehn, D.A., Spaulding, A.C. et al. Influence of surgeon specialty and volume on the utilization of minimally invasive surgery and outcomes for colorectal cancer: a retrospective review. Surg Endosc 35, 5480–5488 (2021). https://doi.org/10.1007/s00464-020-08039-9

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  • DOI: https://doi.org/10.1007/s00464-020-08039-9

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