title: The impact of hospital volume on surgical outcome in patients with rectal cancer.
abstract: OBJECTIVE
  This study was designed to investigate, in a population-based setting, the surgical outcome in patients with rectal cancer according to the hospital volume.
  
  
  METHODS
  Since 1995 all patients with rectal cancer have been registered in the Swedish Rectal Cancer Registry. Hospitals were classified, according to number treated per year, as low-volume, intermediate-volume, or high-volume hospitals (<11, 11-25, or >25 procedures per year). Postoperative mortality, reoperation rate within 30 days, local recurrence rate, and overall five-year survival were studied. For postoperative morbidity and mortality the whole cohort from 1995 to 2003 (n = 10,425) was used. For cancer-related outcome only, those with five-year follow-ups, from 1995 to 1998, were used (n = 4,355).
  
  
  RESULTS
  In this registry setting the postoperative mortality rate was 3.6% in low-volume hospitals, and 2.2% in intermediate-volume and high-volume hospitals (P = 0.002). The reoperation rate was 10%, with no differences according to volume. The overall local recurrence rates were 9.4%, 9.3%, and 7.5%, respectively (P = 0.06). Significant difference was found among the nonirradiated patients (P = 0.004), but not among the irradiated patients (P = 0.45). No differences were found according to volume in the absolute five-year survival.
  
  
  CONCLUSIONS
  Postoperative mortality and local recurrence in nonirradiated patients were lower in high-volume hospitals. No difference was seen between volumes in reoperation rates, overall local recurrence, or absolute five-year survival.
authors.affiliation: Department of Surgery, Ersta Hospital, Stockholm, Sweden. marit.kressner@erstadiakoni.se
authors.forename: Marit
authors.initials: M
authors.lastname: Kressner
authors.forename: Måns
authors.initials: M
authors.lastname: Bohe
authors.forename: Björn
authors.initials: B
authors.lastname: Cedermark
authors.forename: Michael
authors.initials: M
authors.lastname: Dahlberg
authors.forename: Lena
authors.initials: L
authors.lastname: Damber
authors.forename: Gudrun
authors.initials: G
authors.lastname: Lindmark
authors.forename: Björn
authors.initials: B
authors.lastname: Ojerskog
authors.forename: Rune
authors.initials: R
authors.lastname: Sjödahl
authors.forename: Robert
authors.initials: R
authors.lastname: Johansson
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006276:Health Facility Size; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D016526:Workload