Influence of hospital procedure volume on outcomes following surgery for colon cancer Journal Article


Authors: Schrag, D.; Cramer, L. D.; Bach, P. B.; Cohen, A. M.; Warren, J. L.; Begg, C. B.
Article Title: Influence of hospital procedure volume on outcomes following surgery for colon cancer
Abstract: Context: Survival following high-risk cancer surgery, such as pancreatectomy and esophagectomy, is superior at hospitals where high volumes of these procedures are performed. Conflicting evidence exists as to whether the association between hospital experience and favorable health outcomes also applies to more frequently performed operations, such as those for colon cancer. Objective: To determine whether hospital procedure volume predicts survival following colon cancer surgery. Design, Setting, and Participants: Retrospective cohort study of data from the Surveillance, Epidemiology and End Results-Medicare linked database on 27986 colon cancer patients aged 65 years and older who had surgical resection for primary adenocarcinoma diagnosed between 1991 and 1996. Main Outcome Measures: Thirty-day postoperative mortality and overall and cancer-specific long-term survival, by hospital procedure volume. Results: We found small differences in 30-day postoperative mortality for patients treated at low- vs high-volume hospitals (3.5% at hospitals in the top-volume quartile vs 5.5% at hospitals in the bottom-volume quartile). However, the correlation was statistically significant and persisted after adjusting for age at diagnosis, sex, race, cancer stage, comorbid illness, socioeconomic status, and acuity of hospitalization (P<.001). The association was evident for subgroups with stage I, II, and III disease. Hospital volume directly correlated with survival beyond 30 days and also was not attributable to differences in case mix (P<.001). The association between hospital volume and long-term survival was concentrated among patients with stage II and III disease (P<.001 for both). Among stage III patients, variation in use of adjuvant chemotherapy did not explain this finding. Conclusion: Our data suggest that hospital procedure volume predicts clinical outcomes following surgery for colon cancer, although the absolute magnitudes of these differences are modest in comparison with the variation observed for higher-risk cancer surgeries.
Keywords: cancer survival; treatment outcome; aged; survival analysis; cancer surgery; retrospective studies; major clinical study; united states; cancer staging; antineoplastic agent; cancer grading; adenocarcinoma; colonic neoplasms; data base; age; hospital care; social status; medicare; survival time; hospitalization; colon cancer; adjuvant chemotherapy; experience; comorbidity; outcome and process assessment (health care); surgical mortality; seer program; high risk population; regression analysis; surgery department, hospital; digestive system surgical procedures; race; sex; elective surgery; hospital mortality; case mix; humans; human; male; female; priority journal; article; surgical ward
Journal Title: JAMA - Journal of the American Medical Association
Volume: 284
Issue: 23
ISSN: 0098-7484
Publisher: American Medical Association  
Date Published: 2000-12-20
Start Page: 3028
End Page: 3035
Language: English
PUBMED: 11122590
PROVIDER: scopus
DOI: 10.1001/jama.284.23.3028
DOI/URL:
Notes: Export Date: 18 November 2015 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Colin B Begg
    285 Begg
  2. Deborah Schrag
    143 Schrag
  3. Alfred M Cohen
    244 Cohen
  4. Laura Cramer
    17 Cramer
  5. Peter Bach
    250 Bach