Surgeon Volume and Elective Resection for Colon Cancer: An Analysis of Outcomes and Use of Laparoscopy - 19/05/14

Doi : 10.1016/j.jamcollsurg.2014.01.057

Rachelle N. Damle, MD ^a,^⁎ , Christopher W. Macomber, MD, MBA ^a, Julie M. Flahive, MS ^b, Jennifer S. Davids, MD ^c, W. Brian Sweeney, MD, FACS ^c, Paul R. Sturrock, MD ^c, Justin A. Maykel, MD, FACS ^c, Heena P. Santry, MD, FACS ^b, Karim Alavi, MD, FACS ^c
^a Department of Surgery, University of Massachusetts Medical School, Worcester, MA
^b Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA
^c Division of Colorectal Surgery, University of Massachusetts Medical School, Worcester, MA

^∗Correspondence address: Rachelle N Damle, MD, University of Massachusetts, 55 Lake Ave Room S3-752, Worcester, MA 01655.

Abstract

Background

Surgeon volume may be an important predictor of quality and cost outcomes. We evaluated the association between surgeon volume and quality and cost of surgical care in patients with colon cancer.

Study Design

We performed a retrospective study of patients who underwent resection for colon cancer, using data from the University HealthSystem Consortium from 2008 to 2011. Outcomes evaluated included use of laparoscopy, ICU admission, postoperative complications, length of stay, and total direct hospital costs by surgeon volume. Surgeon volume was categorized according to high (HVS), medium (MVS), and low (LVS) average annual volumes.

Results

A total of 17,749 patients were included in this study. The average age of the cohort was 65 years and 51% of patients were female. After adjustment for potential confounders, compared with LVS, HVS and MVS were more likely to use laparoscopy (HVS, odds ratio [OR] 1.27, 95% CI 1.15, 1.39; MVS, OR 1.16 95% CI 1.65, 1.26). Postoperative complications were significantly lower in patients operated on by HVS than LVS (OR 0.77 95% CI 0.76, 0.91). The HVS patients were less likely to require reoperation than those in the LVS group (OR 0.70, 95% CI 0.53, 0.92) Total direct costs were $927 (95% CI -$1,567 to -$287) lower in the HVS group compared with the LVS group.

Conclusions

Higher quality, lower cost care was achieved by HVS in patients undergoing surgery for colon cancer. An assessment of differences in processes of care by surgeon volume may help further define the mechanism for this observed association.

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Abbreviations and Acronyms : CRC, HVS, LAC, LVS, MVS, OR, UHC

Plan

Methods

Source of data

Outcomes measures

Surgeon and hospital volume categories

Statistical analysis

Results

Patient and surgeon characteristics

Study strengths and limitations

Conclusions

Author Contributions

	Disclosure Information: Nothing to disclose.
	Support: Dr Santry received the University of Massachusetts Clinical Scholar Award (HPS) UL1RR031982, 1KL2RR031981-01, and UL1TR000161 from the NIH.