Surgeon Volume Correlates with Reduced Mortality and Improved Quality in the Surgical Management of Diverticulitis.
BACKGROUND
Volume has been shown to be an important determinant of quality and cost outcomes.


METHODS
We performed a retrospective study of patients who underwent surgery for diverticulitis using the University HealthSystem Consortium database from 2008–2012. Outcomes evaluated included minimally invasive approach, stoma creation, intensive-care admission, post-operative complications, length of stay, and total direct hospital costs by surgeon volume. Surgeon volume was categorized into four categories by mean annual volumes: very-high (VHVS) (>31), high (HVS) (13–31), medium (MVS) (6–12), and low (LVS) (≤5).


RESULTS
A total of 19,212 patients with a mean age of 59 years, 54 % female makeup, and 55 % rate of private insurance were included. Similar to the unadjusted analysis, multivariable analysis revealed decreasing odds of stoma creation, complications, ICU admission, reoperation, readmission, and inpatient mortality with increasing surgeon volume. Additionally, compared with LVS, a higher surgeon volume was associated with higher rates of the minimally invasive approach. Median length of stay and costs were also notably lower with increasing surgeon volume.


CONCLUSIONS
Quality and the use of minimally invasive technique are tightly associated with surgeon volume. Further studies are necessary to validate the direct association of volume with outcomes in surgery for diverticulitis.
Rachelle N
RN
Damle
Julie M
JM
Flahive
Jennifer S
JS
Davids
W Brian
WB
Sweeney
Paul R
PR
Sturrock
Justin A
JA
Maykel
Karim
K
Alavi
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D004238:Diverticulitis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies