Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection

Background and Objectives A strong association between high hospital procedure volume and survival following colon cancer resection has been demonstrated. However, the importance of surgeon case volume as a determinant of outcome has been less well studied, and it is unclear whether hospital or surg...

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Bibliographic Details
Published in:Journal of surgical oncology 2003-06, Vol.83 (2), p.68-78
Main Authors: Schrag, Deborah, Panageas, Katherine S., Riedel, Elyn, Hsieh, Lillian, Bach, Peter B., Guillem, Jose G., Begg, Colin B.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cohort Studies
colon cancer surgery
Colonic Neoplasms - epidemiology
Colonic Neoplasms - mortality
Colonic Neoplasms - surgery
Digestive System Surgical Procedures - statistics & numerical data
Female
Hospital Mortality
hospital volume
Humans
Male
Outcome Assessment (Health Care)
SEER Program
surgeon volume
Surgery Department, Hospital - statistics & numerical data
Survival Rate
Treatment Outcome
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Summary:Background and Objectives A strong association between high hospital procedure volume and survival following colon cancer resection has been demonstrated. However, the importance of surgeon case volume as a determinant of outcome has been less well studied, and it is unclear whether hospital or surgeon volume is the more powerful predictor of outcomes. Methods A retrospective population‐based cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database identified 24,166 colon cancer patients aged 65 years and older who had surgery for a primary tumor diagnosed in 1991–1996 in a SEER area. Hospital and surgeon‐specific procedure volume was ascertained based on the number of claims submitted over the 6‐year study period. Outcome measures were mortality at 30 days and 2 years, overall survival, and the frequency of operations requiring an intestinal stoma. Age, sex, race, comorbid illness, cancer stage, socioeconomic status, emergent hospitalization, and the presence of obstruction/perforation were used to adjust for differences in case‐mix. Results After adjusting for surgeon procedure volume, high hospital procedure volume remained a strong predictor of low post‐operative mortality rates (P 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.10244