title: No difference between lowest and highest volume hospitals in outcome after colorectal cancer surgery in the southern Netherlands.
abstract: OBJECTIVE
  To investigate the quality of surgical colorectal cancer (CRC) care in the southern Netherlands by evaluating differences between the five hospitals with the lowest volume and the five hospitals with the highest volume.
  
  
  METHODS
  Patients who underwent resection for primary CRC diagnosed between 2008 and 2011 in southern Netherlands were included (n = 5655). The five hospitals performing <130 resections/year were classified 'low volume'; the five hospitals performing ≥ 130 resections/year 'high volume'. Differences in surgical approach, circumferential resection margins (CRM), anastomotic leakage and 30-day mortality between hospital volumes were analysed using Chi(2) tests. Expected proportions anastomotic leakage and 30-day mortality were calculated using multivariable logistic regression. Crude 3-year survival was calculated using Kaplan-Meier curves. Cox regression was used to discriminate independent risk factors for death.
  
  
  RESULTS
  23% of patients with locally advanced rectal cancer (LARC) diagnosed in a low volume centre was referred to a high volume centre. Patients with colon cancer underwent less laparoscopic surgery and less urgent surgery in low compared to high volume hospitals (10% versus 32%, p < 0.0001, and 8% versus 11%, p = 0.003, respectively). For rectal cancer, rates of abdominoperineal resections versus low anterior resections, and CRM were not associated with hospital volume. Anastomotic leakage, 30-day mortality, and survival did not differ between hospital volumes.
  
  
  CONCLUSIONS
  In southern Netherlands, low volume hospitals deliver similar high quality surgical CRC care as high volume hospitals in terms of CRM, anastomotic leakage and survival, also after adjustment for casemix. However, this excludes LARC since a substantial proportion was referred to high volume hospitals.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, P.O. Box 231, 5600 AE Eindhoven, The Netherlands. Electronic address: f.van.erning@ikz.nl.
authors.forename: F N
authors.initials: FN
authors.lastname: van Erning
authors.forename: L N
authors.initials: LN
authors.lastname: van Steenbergen
authors.forename: W T
authors.initials: WT
authors.lastname: van den Broek
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology*; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000453:epidemiology*; D009426:Netherlands; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anastomotic leakage; Circumferential resection margins; Colorectal cancer; Hospital volume; Surgical outcome; Survival