Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery

Borowski, David W; Kelly, S. B.; Bradburn, D. M.; Wilson, Robert; Gunn, Andrew J.; Ratcliffe, Amy

doi:10.1002/bjs.5721

Cited by 120 publications

(102 citation statements)

References 13 publications

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“…Previous research has reported improved outcomes among patients with rectal cancer who are treated by surgeons with subspecialty training, including increased use of sphincter-preserving surgery, [12][13][14][15] decreased local recurrence, 12,16 decreased anastomotic leak, 16,17 decreased postoperative mortality 16 and improved disease-specific survival. 16,18 It has been suggested that this variation in outcomes may reflect differences in surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Self-reported practice patterns and knowledge of rectal cancer care among Canadian general surgeons

2014

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Section: Discussionmentioning

confidence: 99%

Self-reported practice patterns and knowledge of rectal cancer care among Canadian general surgeons

2014

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“…The fourth period covered the years 2010 to 2013. 1757 patients identified from previous study [26] 67 with missing data 34 with data found Based on the between-hospital differences in average annual pouch procedures performed, we categorized hospital volume as very low (1-5 cases/year), low (6-10 cases/year), intermediate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) cases/year) and high (> 20 cases/year). For this categorization, we divided the total number of procedures performed at a department by the total number of calendar years in which pouch procedures were performed.…”

Section: Covariatesmentioning

confidence: 99%

“…While specialization of surgery has been found to improve perioperative outcomes for a wide variety of procedures, especially in the treatment of malignant conditions [19,20], the benefits of specialization in primary pouch surgery are less documented, since most studies examining risk factors for pouch failure are single-centre cohort studies [7]. Of the existing multicentre, national cohort studies on pouch failure, two are limited by short follow-up (median 4.8 and 5.4 years, respectively) [21,22] while a third used a nonvalidated administrative claims code of abdominoperineal excision to define pouch failure [23].…”

Section: Introductionmentioning

confidence: 99%

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

et al. 2018

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Aim Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. MethodThe study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis.Results Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10-and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary nondiversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy.Conclusion In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.

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“…This finding was confirmed in a recent study from Hawkins et al Surgical trainees operating unsupervised by consultants had more surgery specific postoperative complications [16,17]. Borowski et al did not find a reduced risk of perioperative death in emergency colorectal cancer surgery for high-volume surgeons [18]. For long term survival after colorectal cancer surgery, a high surgeon's annual caseload was found to be an independent beneficial prognostic factor [19].…”

Section: Discussionmentioning

confidence: 80%

Morbidity and Mortality after Emergency and Urgent Colorectal Surgery for Malignant and Benign Disease

Ellensen¹,

Elshove-Bolk²,

Baatrup³

2009

TOCOLCJ

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Abstract:Aim: The aim of this study was to determine short and long-term morbidity and mortality rates after emergency colorectal surgery for benign and malignant disease in a high volume tertiary referral hospital in order to define factors predictive for outcome. Material and Methods: Characteristics and outcome of 196 consecutive emergency and 292 consecutive elective colorectal procedures were studied. A total of 91/196 emergency procedures were performed for malignant disease. The procedures reviewed included both palliative and curative procedures performed on an unselected patient population. Results were analysed by Cox regression and Kaplan-Meier analysis. Results: The total 30-day mortality for emergency and elective surgery was 20% and 3 % respectively, 36-month mortality was 48% and 27%. The frequency of major or moderate complications after emergency procedures was 39%. The strongest predictors for 30 day mortality after emergency surgery were ASA score (Odds Ratio 2.5) and age (OR 1.5). Predictors for early postoperative complications were faecal contamination during surgery (OR 4.2) and ASA score (OR 2.0). The strongest predictor for 3 year mortality after emergency surgery was malignant disease (OR = 5.0). Other predictors for long-term outcome were procedures performed and degree of specialization of the surgeon. Conclusions: Short-term outcome is associated with patient and disease related factors, whereas long-term outcome is also correlated to the primary diseases, procedures performed and the degree of specialization of the surgeon. Decisions concerning the level of qualifications required for emergency procedures should be based upon patient and disease related factors as well as the procedure to be performed.

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Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery

Abstract: High-volume surgeons had lower perioperative mortality rates for elective surgery, and were more likely to use restorative rectal procedures.

Cited by 120 publications

References 13 publications

Self-reported practice patterns and knowledge of rectal cancer care among Canadian general surgeons

Self-reported practice patterns and knowledge of rectal cancer care among Canadian general surgeons

Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis

Morbidity and Mortality after Emergency and Urgent Colorectal Surgery for Malignant and Benign Disease

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