title: Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population-based study.
abstract: BACKGROUND
  Patients with colorectal cancer (CRC) who undergo cancer surgeries with higher-volume providers may have better outcomes. The current debate focuses on whether it is hospital volume or surgeon volume that matters more.
  
  
  METHODS
  The authors conducted a nationwide population-based study in Taiwan that enrolled all patients who underwent definitive surgery for newly diagnosed CRC between 2005 and 2011. All patients were divided into 4 quartiles according to hospital and surgeon volume. The main outcome was the 5-year mortality rate, which was analyzed using a frailty model for Cox regression. The authors also conducted fixed and random effects multivariate regression models to examine short-term outcomes and resource use, including operative mortality, hospital stay, emergency department visits within 30 days, and medical expenses. Analyses were adjusted for patient and provider characteristics.
  
  
  RESULTS
  A total of 61,728 patients with CRC were included in the current study. The 5-year mortality rates were 38.7%, 32.8%, 32.0%, and 29.1% in descending order of hospital volume quartiles and were 41.4%, 34.1%, 29.8%, and 27.4% in descending order of surgeon volume quartiles. After adjustment for the individual and provider characteristics, surgeon volume, but not hospital volume, remained a significantly predictive factor of death (P<.001). In addition, those patients with CRC who underwent definitive surgeries performed by higher-volume surgeons had a relatively lower risk of operative mortality, shorter hospital length of stay, and lower medical expenses.
  
  
  CONCLUSIONS
  Patients with CRC who underwent definitive surgery performed by higher-volume providers were found to have better outcomes. Surgeon volume may play a more important role than hospital volume. Cancer 2015;121:2782-2790. © 2015 American Cancer Society.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.|Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Teng
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Lee
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.|Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016526:Workload / Q000706:statistics & numerical data*
keywords: colectomy; colorectal cancer; hospital volume; outcome disparities; surgeon volume