Effects of hospital and surgeon volumes on operating times, postoperative complications, and length of stay following laparoscopic colectomy.
OBJECTIVE
A relationship between procedure volume and outcome in colorectal cancer surgery is clearly documented, but there is little information on the volume-outcome association in laparoscopic colectomy. We conducted this study to clarify the effects of hospital volume and surgeon volume on operating times, postoperative complications, and length of stay following laparoscopic colectomy.


METHODS
We conducted a nationwide multicenter survey, targeting surgical centers registered with the Japan Surgical Society. Using Web-based patient registration, we collected data on patients who underwent laparoscopic colectomy between November 1, 2006 and February 28, 2007. Operating times, postoperative complications, and length of stay were independently regressed against hospital and surgeon volumes, patient backgrounds, and details of surgical procedures, using multivariate analyses.


RESULTS
We analyzed data from 1212 patients at 247 hospitals. The odds ratios for operating times in the surgeon-volume groups with 30-99, 100-199, or >or=200 surgical procedures were 0.47, 0.23, and 0.17, respectively, versus a reference group with <30 procedures. Neither surgeon volume nor hospital volume was significantly associated with the incidence of postoperative complications. Shorter stay was significantly associated with hospital volume, but not with surgeon volume.


CONCLUSIONS
Our analysis of data related to laparoscopic colectomy revealed that surgeons' experience was associated with faster surgery, but not necessarily with reduced operative morbidity.
Yasunaga
Hideo
H
Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
Matsuyama
Yutaka
Y
Ohe
Kazuhiko
K
D000368:Aged; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013997:Time Factors; D000078329:Workforce