Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery

Abstract

Increasing elective colorectal cancer caseload alone may have marginal postoperative benefit.

Laparoscopic colectomy in a district hospital: the single surgeon can be safe

“…The same finding has been demonstrated by other authors 30,31,32 but a UK wide study of Hospital Episode Statistics failed to show a consistent relationship between laparoscopic surgical caseload and patient outcome 33,34 .…”

Readmissions after general surgery: a prospective multicenter audit

“…Despite basing our data collection on a large number of data points identified from previous studies 6,9 , this study did not find any patient factors that were associated with readmissions. The only procedure related factors that were significantly associated with readmissions were complexity of surgery and length of stay, though it is likely that both factors are measuring the same attribute.…”

“…As would be expected, increased volume of work is associated with a higher number of readmissions. Previous studies based on both UK and US data have similarly demonstrated that readmission rates in different cohorts are fairly constant across centres, meaning that the more operations performed, the higher the number of readmissions 6,17,18 . Despite this, the proportion of readmissions between different units does show a degree of variability, that cannot be explained by case mix (more complex work or emergency work).…”

“…Previous work evaluating surgical readmissions in the UK has been limited to single units 4 , readmissions of operated and non-operated patients 5 , and specific types of surgery 6 . We could not identify prospective data that provided a global view on readmissions following general surgery across multiple centres.…”

The rise of big clinical databases

“…Risk adjustment or propensity score methods are commonly used to overcome imbalances in case mix. Recent examples include a comparison of outcome after abdominal or extralevator abdominoperineal excision for low rectal cancer using data from the Spanish rectal cancer registry 27 ( 30 used HES data to look at the impact of National Health Service Trust and surgeon caseload on postoperative outcomes after colorectal cancer resection (Table S3, supporting information). Goode and colleagues 9 investigated whether centre volume had an impact on mortality and complications following an iliac artery intervention.…”