UMCCTS Supported Publications

Title

Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy

UMMS Affiliation

Department of Surgery

Date

6-2014

Document Type

Article

Medical Subject Headings

Aged; Colectomy; Colonic Neoplasms; Colorectal Surgery; Costs and Cost Analysis; Female; Humans; Laparoscopy; Male; *Outcome Assessment (Health Care); Postoperative Complications; Retrospective Studies; Surgical Procedures, Elective

Disciplines

Health Services Research | Neoplasms | Surgery | Translational Medical Research

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. rights reserved.

Rights and Permissions

Citation: Damle RN, Macomber CW, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, Maykel JA, Santry HP, Alavi K. Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg. 2014 Jun;218(6):1223-30. doi: 10.1016/j.jamcollsurg.2014.01.057. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

UMCCTS funding