Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection

Objective To examine the association of surgeon and hospital case volumes with the sh ort-term outcomes of in-hospital death, total hospital charges, and length of stay for resection of colorectal carcinoma. Methods The study design was a cross-sectional analysis of all adult patients who u nderwent resection for colorectal cancer using Maryland state discharge dat a from 1992 to 1998. Cases were divided into three groups based on annual s urgeon case volume-low (less than or equal to 5), medium (5 to 10), and hig h (>10)-and hospital volume-low (<40), medium (40 to 70), and high (greater than or equal to 70). Poisson and multiple linear regression analyses were used to identify differences in outcomes among volume groups while adjusti ng for variations in type of resections performed, cancer stage, patient co morbidities, urgency of admission, and patient demographic variables. Results During the 5-year period, 9739 resections were performed by 812 surgeons at 50 hospitals. The majority of surgeons (81%) and hospitals (58%) were in t he low-volume group. The low-volume surgeons operated on 3461 of the 9739 t otal patients (36%) at an average rate of 1.8 cases per year. Higher surgeo n volume was associated with significant improvement in all three outcomes (in-hospital death, length of stay, and cost). Medium-volume surgeons achie ved results equivalent to high-volume surgeons when they operated in high- or medium-volume hospitals. Conclusions A skewed distribution of case volumes by surgeon was found in this study of patients who underwent resection for large bowel cancer in Maryland. The m ajority of these surgeons performed very few operations for colorectal canc er per year, whereas a minority performed >10 cases per year. Medium-volume surgeons achieved excellent outcomes similar to high-volume surgeons when operating in medium-volume or high-volume hospitals, but not in low-volume hospitals. The results of low-volume surgeons improved with increasing hosp ital volume but never equaled those of the high-volume surgeons.