title: Hospital volume and outcome of rectal cancer surgery in Denmark 1994-99.
abstract: OBJECTIVE
  The association between hospital volumen and outcome of major cancer surgery is being debated at present. We analysed the outcome of rectal cancer surgery in Denmark during the period 1994-99.
  
  
  METHODS
  All patients with a first-time rectal cancer were registered in a national database during the 5-year period. In this observational cohort study, the influence of hospital case volume on resectional procedure, complications, 30-day mortality and 5-year mortality was analysed.
  
  
  RESULTS
  The register comprised 5021 patients. Surgery was performed in 27 hospitals with <15 operations per year, 15 hospitals with 15-30 operations per year and 11 hospitals with >30 operations per year. In a multivariate model, the risk of permanent colostomy was significantly increased in the group of low-volume hospitals. On the contrary, volume did not influence the risk of anastomotic leakage, 30-day mortality and 5-year mortality. However, a large variation in 5-year mortality was observed particularly within the low-volume group of hospitals.
  
  
  CONCLUSIONS
  In this study, only risk of having a permanent colostomy during surgery for rectal cancer was significantly related to hospital case volume. When individual hospitals were analysed, a large variation in 5-year mortality was observed within the low-volume group of hospitals.
authors.affiliation: Department of Surgery, H:S Bispebjerg Hospital, Denmark. HH06@bbh.hosp.dk
authors.forename: H
authors.initials: H
authors.lastname: Harling
authors.forename: S
authors.initials: S
authors.lastname: Bülow
authors.forename: L N
authors.initials: LN
authors.lastname: Møller
authors.forename: T
authors.initials: T
authors.lastname: Jørgensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome