title: Does surgeon case volume influence nonfatal adverse outcomes after rectal cancer resection?
abstract: BACKGROUND
  The aim of this study was to assess the relationship between surgeon and hospital volume and major postoperative complications after rectal cancer surgery, and to define other surgeon and hospital characteristics that may explain observed volume-complication relationships.
  
  
  METHODS
  This was a retrospective cohort design using data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry program for individuals with stage I to III rectal cancer diagnosed between 1992 and 1999 and treated with resection. The patients' Surveillance, Epidemiology, and End Results data were linked with Medicare claims data from 1991 to 2000. The primary outcomes were 30-day postoperative procedural interventions (PPI) to treat surgical complications, such as reoperation. The association between surgeon volume and PPI was examined using logistic regression modeling with adjustment for covariates.
  
  
  RESULTS
  The odds of a rectal cancer patient requiring a PPI is notably less if the operation is performed by one of a small subset of very high volume surgeons (unadjusted odds ratio 0.53; 95% CI 0.31 to 0.92). Board certification in colorectal surgery did not alter the relationship between surgeon volume and PPI, although surgeon age did, with mid-career surgeons having the lowest rates of PPI, regardless of practice volume. When adjusted for surgeon age, surgeon volume is no longer a marked predictor of complications (adjusted odds ratio 0.57; 95% CI 0.30 to 1.09).
  
  
  CONCLUSIONS
  Overall, rectal cancer operations are safe, with a low frequency of severe complications. A subset of very high volume rectal surgeons performs these operations with fewer complications that require procedural intervention or reoperation. Surgeon age, as an indicator of experience, also contributes modestly to outcomes. These data do not justify regionalizing rectal cancer care based on safety concerns.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Billingsley
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
authors.forename: Pamela
authors.initials: P
authors.lastname: Green
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
authors.forename: Barbara
authors.initials: B
authors.lastname: Matthews
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Dobie
authors.forename: William
authors.initials: W
authors.lastname: Barlow
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D019090:Case Management / Q000458:organization & administration / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D006276:Health Facility Size / Q000706:statistics & numerical data; D006801:Humans; D009367:Neoplasm Staging; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data