 |
|
Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer SurgeryUnderstanding the Volume-Outcome Relationship
Kevin G. Billingsley, MD;
Arden M. Morris, MD, MPH;
Jason A. Dominitz, MD, MHS;
Barbara Matthews, MBA;
Sharon Dobie, MD;
William Barlow, PhD;
George E. Wright, PhD;
Laura-Mae Baldwin, MD, MPH
Arch Surg. 2007;142(1):23-31.
Hypothesis Although numerous studies have demonstrated an association between surgical volume and improved outcome in cancer surgery, the specific structures and mechanisms of care that are associated with volume and lead to improved outcomes remain poorly defined. We hypothesize that there are modifiable surgeon and hospital characteristics that explain observed volume-outcome relationships.
Design Retrospective cohort study.
Setting Surveillance, Epidemiology, and End Results cancer registry areas.
Patients Patients aged 66 years and older, diagnosed and surgically treated for stage I, II, or III colon cancer between 1992 and 1996 (n = 22 672).
Main Outcome Measures Thirty-day postoperative mortality and 30-day postoperative procedural interventions, including reoperation and image-guided percutaneous procedures.
Results Surgeon volume, but not hospital volume, is a significant predictor of postoperative procedural intervention (adjusted odds ratio for very high–volume surgeons vs low-volume surgeons, 0.79; 95% confidence interval, 0.64-0.98). In the unadjusted analyses, high hospital volume (odds ratio, 0.67; 95% confidence interval, 0.56-0.81) and very high hospital volume (odds ratio, 0.65; 95% confidence interval, 0.54-0.79) is associated with lower postoperative mortality. Postoperative procedural intervention is not a significant mediator of the relationship between hospital volume and mortality. A single variable—the presence of sophisticated clinical services—was the most important explanatory variable underlying the relationship between hospital volume and mortality.
Conclusions Very high surgeon volume is associated with a reduction in surgical complications. However, the association between increasing hospital volume and postoperative mortality appears to derive mainly from a full spectrum of clinical services that may facilitate the prompt recognition and treatment of complications.
Author Affiliations: Department of Surgery, Oregon Health and Science University, Portland (Dr Billingsley); Department of Surgery, University of Michigan School of Medicine, Ann Arbor (Dr Morris); and Division of Gastroenterology, VA Puget Sound Health Care System (Dr Dominitz), and Department of Family Medicine (Drs Matthews, Dobie, Wright, and Baldwin), University of Washington School of Medicine, and Cancer Research and Biostatistics (CRAB) (Dr Barlow), Seattle, Wash.
RELATED ARTICLE
Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer Surgery—Invited Critique
Clifford Ko and Marcia McGory
Arch Surg. 2007;142(1):32.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model
Ra et al.
Ann. Surg. Oncol. 2008;15:1577-1584.
ABSTRACT
| FULL TEXT
Does Practice Make Perfect?
Hogan and Winter
Ann. Surg. Oncol. 2008;15:1267-1270.
ABSTRACT
| FULL TEXT
Complications in Antireflux Surgery: National-Based Analysis of Laparoscopic and Open Fundoplications--Invited Critique
Ferzli
Arch Surg 2008;143:365-365.
FULL TEXT
Are Surgical Outcomes for Lung Cancer Resections Improved at Teaching Hospitals?
Meguid et al.
Ann. Thorac. Surg. 2008;85:1015-1025.
ABSTRACT
| FULL TEXT
|
