Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery

• Published in: British journal of surgery 2007-07, Vol.94 (7), p.880-889
• Main Authors: Borowski, D. W., Kelly, S. B., Bradburn, D. M., Wilson, R. G., Gunn, A., Ratcliffe, A. A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical; Biological and medical sciences; Colorectal Neoplasms - surgery; Colorectal Surgery - statistics & numerical data; Consultants - statistics & numerical data; England; Female; General aspects; Health participants; Humans; Male; Medical sciences; Medical Staff, Hospital - statistics & numerical data; Middle Aged; Ostomy - methods; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Specialization - statistics & numerical data; Surgical Wound Dehiscence - etiology; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5721

Background: Several studies have shown a relationship between surgeon volume and outcomes in colorectal cancer surgery. The aim of this study was to determine the impact of surgeon volume and specialization on primary tumour resection rate, restoration of bowel continuity following rectal cancer resection, anastomotic leakage and perioperative mortality. Methods: The Northern Region Colorectal Cancer Audit Group conducts a population‐based audit of patients with colorectal cancer managed by surgeons. This study examined 8219 patients treated between 1998 and 2002. Outcomes were modelled using multivariate logistic regression analysis. Results: Tumour resection was performed in 6949 (93·8 per cent) of 7411 patients. High‐volume surgeons with an annual caseload of at least 18·5 (odds ratio (OR) 1·53 (95 per cent confidence interval (c.i.) 1·10 to 2·12); P = 0·012) and colorectal specialists (OR 1·42 (95 per cent c.i. 1·06 to 1·90); P = 0·018) were more likely to perform elective sphincter‐saving rectal surgery. In elective surgery, the risk of perioperative death was lower for high‐volume surgeons (OR 0·58 (95 per cent c.i. 0·44 to 0·76); P < 0·001), but this was not the case in emergency surgery. Conclusion: High‐volume surgeons had lower perioperative mortality rates for elective surgery, and were more likely to use restorative rectal procedures. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Improved outcomes with high volume surgeons