title: Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality.
abstract: BACKGROUND
  The purpose of this study was to determine whether morbidity and mortality in patients undergoing elective resection of colon cancer are associated with surgeon or hospital volume.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, we identified all adult patients who underwent elective resection for colon cancer as their primary procedure between 2003 and 2007. Cases were divided into three groups according to the mean number of resections performed annually by each surgeon: low volume (≤4/year), intermediate volume (5-9/year), or high volume (≥10/year). Annual hospital case-load was also categorized as low volume (≤30/year), intermediate volume (31-60/year), and high volume (≥61/year). Multiple logistic regression models were used to identify differences in morbidity and mortality.
  
  
  RESULTS
  A total of 54,000 patients underwent resection of colon cancer by 7,313 surgeons in 1,398 hospitals. After adjusting for important covariates including hospital volume, colon cancer resection by high-volume surgeons was an independent predictor of decreased morbidity (odds ratio [OR], 0.91; 95% CI, 0.85-0.97) and mortality (OR, 0.75; 95% CI, 0.65-0.86). Mortality was lowest among patients operated on by high-volume surgeons in high-volume hospitals (2.2% vs. 3.9%; OR, 0.56; 95% CI, 0.46-0.68).
  
  
  CONCLUSIONS
  In patients undergoing elective resection of colon cancer, procedures done by high-volume surgeons are associated with decreased morbidity and mortality.
authors.affiliation: Department of Surgery, University of Calgary, Calgary, AB, Canada. sebastien.drolet.chx@gmail.com
authors.forename: Sebastien
authors.initials: S
authors.lastname: Drolet
authors.forename: Anthony R
authors.initials: AR
authors.lastname: MacLean
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Abdel Aziz M
authors.initials: AA
authors.lastname: Shaheen
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: W Donald
authors.initials: WD
authors.lastname: Buie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D005260:Female; D017722:Hospital Charges; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors