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Surgical Unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy)

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Abstract

Background

The aim of this study was to evaluate the impact of Surgical Unit volume on the 30-day reoperation rate in patients with CRC.

Methods

Data were extracted from the regional Hospital Discharge Dataset and included patients who underwent elective resection for primary CRC in the Veneto Region (2005–2013). The primary outcome measure was any unplanned reoperation performed within 30 days from the index surgery. Independent variables were: age, gender, comorbidity, previous abdominal surgery, site and year of the resection, open/laparoscopic approach and yearly Surgical Unit volume for colorectal resections as a whole, and in detail for colonic, rectal and laparoscopic resections. Multilevel multivariate regression analysis was used to evaluate the impact of variables on the outcome measure.

Results

During the study period, 21,797 elective primary colorectal resections were performed. The 30-day reoperation rate was 5.5 % and was not associated with Surgical Unit volume. In multivariate multilevel analysis, a statistically significant association was found between 30-day reoperation rate and rectal resection volume (intermediate-volume group OR 0.75; 95 % CI 0.56–0.99) and laparoscopic approach (high-volume group OR 0.69; 95 % CI 0.51–0.96).

Conclusions

While Surgical Unit volume is not a predictor of 30-day reoperation after CRC resection, it is associated with an early return to the operating room for patients operated on for rectal cancer or with a laparoscopic approach. These findings suggest that quality improvement programmes or centralization of surgery may only be required for subgroups of CRC patients.

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References

  1. Birkmeyer JD, Dimick JB, Birkmeyer N (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:626–632

    Article  PubMed  Google Scholar 

  2. Almoudaris AM, Burns EM, Bottle A et al (2013) Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery. Gut 62:423–429

    Article  PubMed  Google Scholar 

  3. Surgical Care and Outcomes Assessment Program (SCOAP) (2012) Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 214:909–918

    Article  Google Scholar 

  4. NHS Scotland—Scottish Cancer Taskforce. Colorectal cancer clinical quality performance indicators. Final Publication v2.0. November 2013. http://healthcareimprovementscotland.org/his/idoc.ashx?docid=0213323f-caae-4e15-ace7-f1f252c1e17f&version=-1. Accessed on 31 Mar 2015

  5. Burns EM, Bottle A, Almoudaris AM et al (2013) Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery. Br J Surg 100:1531–1538

    Article  PubMed  CAS  Google Scholar 

  6. Morris AM, Baldwin L-M, Matthews B et al (2007) Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 245:73–79

    Article  PubMed  PubMed Central  Google Scholar 

  7. Krarup PM, Jorgensen LN, Andreasen AH, Harling H, Danish Colorectal Cancer Group (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14:661–667

    Article  Google Scholar 

  8. Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH (2012) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 3:CD005391

  9. Burns EM, Mamidanna R, Currie A et al (2014) The role of caseload in determining outcome following laparoscopic colorectal cancer resection: an observational study. Surg Endosc 28:134–142

    Article  PubMed  Google Scholar 

  10. Schrag D, Panageas KS, Riedel E et al (2002) Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 236:583–592

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zorzi M, Fedato C, Cogo C et al (2015) I programmi di screening oncologici del Veneto. Rapporto 2012–2013. https://www.registrotumoriveneto.it/screening/presentazione.php

  12. Mahoney FI, Barthel DW (1965) Functional Evaluation: the Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  13. Burns EM, Bottle A, Aylin P, Darzi A, Nicholls RJ, Faiz O (2011) Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 343:d4836

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wibe A, Eriksen MT, Syse A, Tretli S, Myrvold HE, Søreide O (2005) Norwegian Rectal Cancer Group. Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level. Br J Surg 92:217–224

    Article  PubMed  CAS  Google Scholar 

  15. Zorzi M, Fedeli U, Schievano E et al (2014) Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut 64:784–790

    Article  PubMed  Google Scholar 

  16. Borowski DW, Kelly SB, Bradburn DM et al (2007) Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg 94:880–889

    Article  PubMed  CAS  Google Scholar 

  17. Borowski DW, Bradburn DM, Mills SJ, Northern Region Colorectal Cancer Audit Group (NORCCAG) et al (2010) Volume-outcome analysis of colorectal cancer-related outcomes. Br J Surg 97:1416–1430

    Article  PubMed  CAS  Google Scholar 

  18. Marusch F, Koch A, Schmidt U, Pross M, Gastinger I, Lippert H (2001) Hospital caseload and the results achieved inpatients with rectal cancer. Br J Surg 88:1397–1402

    Article  PubMed  CAS  Google Scholar 

  19. Marusch F, Koch A, Schmidt U et al (2001) Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study. Int J Colorectal Dis 16:362–369

    Article  PubMed  CAS  Google Scholar 

  20. Harling H, Bülow S, Møller LN, Jørgensen T, Danish Colorectal Cancer Group (2005) Hospital volume and outcome of rectal cancer surgery in Denmark 1994–1999. Colorectal Dis 7:90–95

    Article  PubMed  CAS  Google Scholar 

  21. Kressner M, Bohe M, Cedermark B et al (2009) The impact of hospital volume on surgical outcome in patients with rectal cancer. Dis Colon Rectum 52:1542–1549

    Article  PubMed  Google Scholar 

  22. Association of Coloproctology of Great Britain and Ireland, Clinical Effectiveness Unit at The Royal College of Surgeons of England, The Health and Social Care Information Centre. National Bowel Cancer Audit Report 2014. http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2014-15/nati-clin-audi-supp-prog-bowe-canc-2014-rep1.pdf. Accessed 02/04/2015

  23. Moghadamyeghaneh Z, Masoomi H, Mills SD et al (2014) Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS 18 pii:e2014.00230

  24. Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

    Article  PubMed  Google Scholar 

  25. Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Darzi AW, Kennedy RH (2009) Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006. Dis Colon Rectum 52:1695–1704

    Article  PubMed  CAS  Google Scholar 

  26. Bilimoria KY, Bentrem DJ, Merkow RP et al (2008) Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 12:2001–2009

    Article  PubMed  Google Scholar 

  27. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145

  28. Damle RN, Macomber CW, Flahive JM et al (2014) Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg 218:1223–1230

    Article  PubMed  PubMed Central  Google Scholar 

  29. Aylin P, Bottle A, Elliott P, Jarman B (2007) Surgical mortality: hospital episode statistics v central cardiac audit database. BMJ 335:839

    Article  PubMed  PubMed Central  Google Scholar 

  30. Garout M, Tilney HS, Tekkis PP, Aylin P (2008) Comparison of administrative data with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database. Int J Colorectal Dis 23:155–163

    Article  PubMed  Google Scholar 

  31. Burns EM, Rigby E, Mamidanna R et al (2012) Systematic review of discharge coding accuracy. J Public Health (Oxf) 34:138–148

    Article  CAS  Google Scholar 

  32. Almoudaris AM, Burns EM, Mamidanna R et al (2011) Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection. Br J Surg 98:1775–1783

    Article  PubMed  CAS  Google Scholar 

  33. Merkow RP, Hall BL, Cohen ME et al (2013) Validity and feasibility of the American College of Surgeons colectomy composite outcome quality measure. Ann Surg 257:483–489

    Article  PubMed  Google Scholar 

  34. Mamidanna R, Burns EM, Bottle A et al (2012) Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study. Arch Surg 147:219–227

    Article  PubMed  Google Scholar 

  35. Mamidanna R, Eid-Arimoku L, Almoudaris AM et al (2012) Poor 1-year survival in elderly patients undergoing nonelective colorectal resection. Dis Colon Rectum 55:788–796

    Article  PubMed  Google Scholar 

  36. Nachiappan S, Burns EM, Faiz O (2013) Validity and Feasibility of the American College of Surgeons Colectomy composite outcome quality measure. Ann Surg 261:e158

    Article  Google Scholar 

  37. Renzulli P, Laffer UT (2005) Learning curve: the surgeon as a prognostic factor in colorectal cancer surgery. Recent Results Cancer Res 165:86–104

    Article  PubMed  Google Scholar 

  38. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Eng J Med 361:1368–1375

    Article  CAS  Google Scholar 

  39. Howell AM, Panesar SS, Burns EM, Donaldson LJ, Darzi A (2014) Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery. Ann Surg 259:630–641

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported in part by a grant from the AIRC Foundation and in part by a grant from Italian Ministry of Health (RF-2011-02349645). The article was reviewed and edited for English language usage by American Journal Experts.

Author information

Authors and Affiliations

  1. Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica chirurgica I, University of Padova, Via giustiniani 2, 35128, Padua, Italy

    S. Pucciarelli, A. Barina & D. Nitti

  2. Surgical Unit - Local Health Unit n°4, Veneto Region, Italy

    A. Chiappetta & M. Rebonato

  3. Padova Hospital, Padua, Italy

    G. Giacomazzo

  4. Epidemiological Service of the Veneto Region, Padua, Italy

    N. Gennaro & M. Saugo

Authors
  1. S. Pucciarelli
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  2. A. Chiappetta
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  3. G. Giacomazzo
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  4. A. Barina
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  5. N. Gennaro
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  6. M. Rebonato
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  7. D. Nitti
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  8. M. Saugo
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Corresponding author

Correspondence to A. Barina.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was not required for this type of study.

Appendix

Appendix

See Table 5.

Table 5 ICD9-CM codes identifying reoperations and imaging-guided interventions requiring access to the operating room after colorectal resection
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Pucciarelli, S., Chiappetta, A., Giacomazzo, G. et al. Surgical Unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy). Tech Coloproctol 20, 31–40 (2016). https://doi.org/10.1007/s10151-015-1388-0

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  • DOI: https://doi.org/10.1007/s10151-015-1388-0

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