Abstract
Purpose
A relationship between procedure volume and outcome in colorectal cancer surgery is clearly documented, but there is little information on the volume-outcome association in laparoscopic colectomy. We conducted this study to clarify the effects of hospital volume and surgeon volume on operating times, postoperative complications, and length of stay following laparoscopic colectomy.
Methods
We conducted a nationwide multicenter survey, targeting surgical centers registered with the Japan Surgical Society. Using Web-based patient registration, we collected data on patients who underwent laparoscopic colectomy between November 1, 2006 and February 28, 2007. Operating times, postoperative complications, and length of stay were independently regressed against hospital and surgeon volumes, patient backgrounds, and details of surgical procedures, using multivariate analyses.
Results
We analyzed data from 1212 patients at 247 hospitals. The odds ratios for operating times in the surgeon-volume groups with 30–99, 100–199, or ≥200 surgical procedures were 0.47, 0.23, and 0.17, respectively, versus a reference group with <30 procedures. Neither surgeon volume nor hospital volume was significantly associated with the incidence of postoperative complications. Shorter stay was significantly associated with hospital volume, but not with surgeon volume.
Conclusions
Our analysis of data related to laparoscopic colectomy revealed that surgeons’ experience was associated with faster surgery, but not necessarily with reduced operative morbidity.
Similar content being viewed by others
References
Kojima M, Konishi F, Okada M, Nagai H. Laparoscopic colectomy versus open colectomy for colorectal carcinoma: a retrospective analysis of patients followed up for at least 4 years. Surg Today 2004;34:1020–1024.
Nakamura T, Ihara A, Mitomi H, Kokubo Y, Sato T, Ozawa H, et al. Gastrointestinal stromal tumor of the rectum resected by laparoscopic surgery: report of a case. Surg Today 2007;37:1004–1008.
Schwenk W, Haase O, Neudecker J, Muller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Colorectal Cancer Group Cochrane Database of Systematic Reviews 2, 2008.
Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group. Laparoscopic assisted vs open colectomy for colon cancer. A meta-analysis. Arch Surg 2007;142:298–303.
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.
Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF. The influence of hospital and surgeon volume on in-patient mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 2002;131:6–15.
Schrag D, Panageas KS, Riedel E, Hsieh L, Bach PB, Guillem JG, et al. Surgeon volume compared with hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol 2003;83:68–78.
Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of inhospital outcome for colon cancer resection? Surgery 2002;132:268–273.
Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 2002;236:583–592.
Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 1999;230:404–411.
Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000;284:3028–3035.
Hodgson DC, Zhang W, Zaslavsky AM, Fuchs CS, Wright WE, Ayanian JZ. Relation of hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst 2003;95:708–716.
Urbach DR, Bell CM, Austin PC. Differences in operative mortality between high-and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. CMAJ 2003;168:1409–1414.
Parry JM, Collins S, Mathers J, Scott NA, Woodman CB. Influence of volume of work on the outcome of treatment for patients with colorectal cancer. Br J Surg 1999;86:475–481.
Simunovic M, To T, Baxter N, Balshem A, Ross E, Cohen Z, et al. Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population. J Gastrointest Surg 2000;4:324–330.
Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, Schrag D, Ayanian JZ, et al. Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study. J Clin Oncol 2004;22:166–174.
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery. Ann Surg 2005;242:83–91.
Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, et al. Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 2001;15:116–120.
Liang K-Y, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.
Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001;44:217–222.
Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 1997;132:41–44.
Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P. Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 2003;46:1371–1378.
Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y for the Colorectal Cancer Study Group (CCSG) of Japan Clinical Oncology Group. Randomized controlled trial to evaluate laparoscopic surgery for Colorectal Cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 2005;35:475–477.
Smith JAE, King PM, Lane RHS, Thompson MR. Evidence of the effect of “specialization” on the management, surgical outcome and survival from colorectal cancer in Wessex. Br J Surg 2003;90:583–592.
McArdle CS, Hole DJ. Influence of volume and specialization on survival following surgery for colorectal cancer. Br J Surg 2004;91:610–617.
Callahan MA, Christos PJ, Gold HT, Mushlin AI, Daly JM. Influence of surgical subspecialty training on in-hospital mortality for gastrectomy and colectomy patients. Ann Surg 2003;238:629–636.
Author information
Authors and Affiliations
Consortia
Rights and permissions
About this article
Cite this article
Yasunaga, H., Matsuyama, Y., Ohe, K. et al. Effects of hospital and surgeon volumes on operating times, postoperative complications, and length of stay following laparoscopic colectomy. Surg Today 39, 955–961 (2009). https://doi.org/10.1007/s00595-008-4052-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-008-4052-8