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


Authors: Schrag, D.; Panageas, K. S.; Riedel, E.; Hsieh, L.; Bach, P. B.; Guillem, J. G.; Begg, C. B.
Article Title: Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection
Abstract: 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 < 0.001 for each outcome with and without adjustment for surgeon procedure volume). Surgeon-specific procedure volume was also an important predictor of surgical outcomes (P = 0.002 for 30-day mortality, P = 0.001 for 2-year mortality), although this effect was attenuated after adjusting for hospital volume (P = 0.03 for 30-day mortality, P = 0.02 for 2-year mortality). Hospital volume and surgeon volume were each an important predictor of the ostomy rate. Among high volume institutions and surgeons, individual providers with unusually high ostomy rates could be identified. Conclusions: Both hospital and surgeon-specific procedure volume predict outcomes following colon cancer resection; but hospital volume may exert a stronger effect. Therefore, efforts to optimize the quality of colon cancer surgery should focus on multidisciplinary aspects of hospital care rather than solely on intraoperative technique. © 2003 Wiley-Liss, Inc.
Keywords: adult; cancer survival; treatment outcome; aged; aged, 80 and over; cancer surgery; survival rate; major clinical study; comparative study; cohort studies; tumor volume; colonic neoplasms; cohort analysis; retrospective study; prediction; outcome assessment (health care); hospital care; hospitalization; colon cancer; surgeon; outcomes research; seer program; socioeconomics; surgery department, hospital; digestive system surgical procedures; hospital mortality; hospital volume; surgeon volume; case mix; humans; human; male; female; priority journal; article; colon cancer surgery
Journal Title: Journal of Surgical Oncology
Volume: 83
Issue: 2
ISSN: 0022-4790
Publisher: Wiley Blackwell  
Date Published: 2003-06-01
Start Page: 68
End Page: 78
Language: English
DOI: 10.1002/jso.10244
PUBMED: 12772198
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Lillian Hsieh
    4 Hsieh
  2. Colin B Begg
    243 Begg
  3. Jose Guillem
    379 Guillem
  4. Deborah Schrag
    137 Schrag
  5. Peter Bach
    206 Bach
  6. Katherine S Panageas
    332 Panageas