title: Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy.
abstract: BACKGROUND
  The relationship between hospital volumes and short-term patients' outcomes of colon cancer (CC) surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1) to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2) to compare the outcomes of urgent and elective CC surgery.
  
  
  METHODS
  A total of 14,200 patients undergoing CC surgery between 2005 and 2010 in the General Surgery Units (GSUs) of the hospitals of Emilia-Romagna region, Northern Italy, were identified from the hospital discharge records database. The outcomes of interest were 30-day in-hospital mortality, re-intervention and 30-day re-admission. Using multilevel analysis, we analyzed the relationship of GSU volumes and focused practice, defined as the percentage of CC operations over total operations, with the three outcomes.
  
  
  RESULTS
  High procedure volumes were associated with a lower risk of 30-day in-hospital mortality, after adjusting for patients' characteristics [aOR (95% CI) = 0.51 (0.33-0.81)]. Stratified analyses for elective and urgent surgery showed that high volumes were associated with a lower 30-day mortality for elective patients [aOR (95% CI) = 0.35 (0.17-0.71)], but not for urgent patients [aOR (95% CI) = 0.72 (0.42-1.24)]. Focused practice was an independent predictor of re-intervention [aOR (95% CI) = 0.67 (0.47-0.97)] and re-admission [aRR (95% CI) = 0.88 (0.78-0.98)].
  
  
  CONCLUSIONS
  The present study adds evidence in support of the notion that patients with CC undergoing surgery at high-volume and focused surgical units experience better short-term outcomes.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Lenzi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Lombardi
authors.forename: Davide
authors.initials: D
authors.lastname: Gori
authors.forename: Nicola
authors.initials: N
authors.lastname: Zanini
authors.forename: Dario
authors.initials: D
authors.lastname: Tedesco
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged