Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery.
BACKGROUND
Several studies have shown a relationship between surgeon volume and outcomes in colorectal cancer surgery. The aim of this study was to determine the impact of surgeon volume and specialization on primary tumour resection rate, restoration of bowel continuity following rectal cancer resection, anastomotic leakage and perioperative mortality.


METHODS
The Northern Region Colorectal Cancer Audit Group conducts a population-based audit of patients with colorectal cancer managed by surgeons. This study examined 8219 patients treated between 1998 and 2002. Outcomes were modelled using multivariate logistic regression analysis.


RESULTS
Tumour resection was performed in 6949 (93.8 per cent) of 7411 patients. High-volume surgeons with an annual caseload of at least 18.5 (odds ratio (OR) 1.53 (95 per cent confidence interval (c.i.) 1.10 to 2.12); P = 0.012) and colorectal specialists (OR 1.42 (95 per cent c.i. 1.06 to 1.90); P = 0.018) were more likely to perform elective sphincter-saving rectal surgery. In elective surgery, the risk of perioperative death was lower for high-volume surgeons (OR 0.58 (95 per cent c.i. 0.44 to 0.76); P < 0.001), but this was not the case in emergency surgery.


CONCLUSIONS
High-volume surgeons had lower perioperative mortality rates for elective surgery, and were more likely to use restorative rectal procedures.
Borowski
D W
DW
Department of Surgery, North Tyneside General Hospital, North Shields, UK.
Kelly
S B
SB
Bradburn
D M
DM
Wilson
R G
RG
Gunn
A
A
Ratcliffe
A A
AA
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000706:statistics & numerical data*; D003253:Consultants / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008875:Middle Aged; D010030:Ostomy / Q000379:methods; D011446:Prospective Studies; D013038:Specialization / Q000706:statistics & numerical data*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome