Does Surgeon Case Volume Influence Nonfatal Adverse Outcomes after Rectal Cancer Resection?

Kevin Billingsley, Arden M. Morris, Pamela Green, Jason A. Dominitz, Barbara Matthews, Sharon A. Dobie, William Barlow, Laura Mae Baldwin

    Research output: Contribution to journalArticle

    32 Citations (Scopus)

    Abstract

    Background: The aim of this study was to assess the relationship between surgeon and hospital volume and major postoperative complications after rectal cancer surgery, and to define other surgeon and hospital characteristics that may explain observed volume-complication relationships. Study Design: This was a retrospective cohort design using data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry program for individuals with stage I to III rectal cancer diagnosed between 1992 and 1999 and treated with resection. The patients' Surveillance, Epidemiology, and End Results data were linked with Medicare claims data from 1991 to 2000. The primary outcomes were 30-day postoperative procedural interventions (PPI) to treat surgical complications, such as reoperation. The association between surgeon volume and PPI was examined using logistic regression modeling with adjustment for covariates. Results: The odds of a rectal cancer patient requiring a PPI is notably less if the operation is performed by one of a small subset of very high volume surgeons (unadjusted odds ratio 0.53; 95% CI 0.31 to 0.92). Board certification in colorectal surgery did not alter the relationship between surgeon volume and PPI, although surgeon age did, with mid-career surgeons having the lowest rates of PPI, regardless of practice volume. When adjusted for surgeon age, surgeon volume is no longer a marked predictor of complications (adjusted odds ratio 0.57; 95% CI 0.30 to 1.09). Conclusions: Overall, rectal cancer operations are safe, with a low frequency of severe complications. A subset of very high volume rectal surgeons performs these operations with fewer complications that require procedural intervention or reoperation. Surgeon age, as an indicator of experience, also contributes modestly to outcomes. These data do not justify regionalizing rectal cancer care based on safety concerns.

    Original languageEnglish (US)
    Pages (from-to)1167-1177
    Number of pages11
    JournalJournal of the American College of Surgeons
    Volume206
    Issue number6
    DOIs
    StatePublished - Jun 2008

    Fingerprint

    Rectal Neoplasms
    Reoperation
    Epidemiology
    Surgeons
    Odds Ratio
    Colorectal Surgery
    Certification
    Medicare
    Registries
    Logistic Models
    Safety

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Does Surgeon Case Volume Influence Nonfatal Adverse Outcomes after Rectal Cancer Resection? / Billingsley, Kevin; Morris, Arden M.; Green, Pamela; Dominitz, Jason A.; Matthews, Barbara; Dobie, Sharon A.; Barlow, William; Baldwin, Laura Mae.

    In: Journal of the American College of Surgeons, Vol. 206, No. 6, 06.2008, p. 1167-1177.

    Research output: Contribution to journalArticle

    Billingsley, Kevin ; Morris, Arden M. ; Green, Pamela ; Dominitz, Jason A. ; Matthews, Barbara ; Dobie, Sharon A. ; Barlow, William ; Baldwin, Laura Mae. / Does Surgeon Case Volume Influence Nonfatal Adverse Outcomes after Rectal Cancer Resection?. In: Journal of the American College of Surgeons. 2008 ; Vol. 206, No. 6. pp. 1167-1177.
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    abstract = "Background: The aim of this study was to assess the relationship between surgeon and hospital volume and major postoperative complications after rectal cancer surgery, and to define other surgeon and hospital characteristics that may explain observed volume-complication relationships. Study Design: This was a retrospective cohort design using data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry program for individuals with stage I to III rectal cancer diagnosed between 1992 and 1999 and treated with resection. The patients' Surveillance, Epidemiology, and End Results data were linked with Medicare claims data from 1991 to 2000. The primary outcomes were 30-day postoperative procedural interventions (PPI) to treat surgical complications, such as reoperation. The association between surgeon volume and PPI was examined using logistic regression modeling with adjustment for covariates. Results: The odds of a rectal cancer patient requiring a PPI is notably less if the operation is performed by one of a small subset of very high volume surgeons (unadjusted odds ratio 0.53; 95{\%} CI 0.31 to 0.92). Board certification in colorectal surgery did not alter the relationship between surgeon volume and PPI, although surgeon age did, with mid-career surgeons having the lowest rates of PPI, regardless of practice volume. When adjusted for surgeon age, surgeon volume is no longer a marked predictor of complications (adjusted odds ratio 0.57; 95{\%} CI 0.30 to 1.09). Conclusions: Overall, rectal cancer operations are safe, with a low frequency of severe complications. A subset of very high volume rectal surgeons performs these operations with fewer complications that require procedural intervention or reoperation. Surgeon age, as an indicator of experience, also contributes modestly to outcomes. These data do not justify regionalizing rectal cancer care based on safety concerns.",
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