title: Surgical Unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy).
abstract: BACKGROUND
  The aim of this study was to evaluate the impact of Surgical Unit volume on the 30-day reoperation rate in patients with CRC.
  
  
  METHODS
  Data were extracted from the regional Hospital Discharge Dataset and included patients who underwent elective resection for primary CRC in the Veneto Region (2005-2013). The primary outcome measure was any unplanned reoperation performed within 30 days from the index surgery. Independent variables were: age, gender, comorbidity, previous abdominal surgery, site and year of the resection, open/laparoscopic approach and yearly Surgical Unit volume for colorectal resections as a whole, and in detail for colonic, rectal and laparoscopic resections. Multilevel multivariate regression analysis was used to evaluate the impact of variables on the outcome measure.
  
  
  RESULTS
  During the study period, 21,797 elective primary colorectal resections were performed. The 30-day reoperation rate was 5.5% and was not associated with Surgical Unit volume. In multivariate multilevel analysis, a statistically significant association was found between 30-day reoperation rate and rectal resection volume (intermediate-volume group OR 0.75; 95% CI 0.56-0.99) and laparoscopic approach (high-volume group OR 0.69; 95% CI 0.51-0.96).
  
  
  CONCLUSIONS
  While Surgical Unit volume is not a predictor of 30-day reoperation after CRC resection, it is associated with an early return to the operating room for patients operated on for rectal cancer or with a laparoscopic approach. These findings suggest that quality improvement programmes or centralization of surgery may only be required for subgroups of CRC patients.
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica chirurgica I, University of Padova, Via giustiniani 2, 35128, Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pucciarelli
authors.affiliation: Surgical Unit - Local Health Unit n°4, Veneto Region, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Chiappetta
authors.affiliation: Padova Hospital, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Giacomazzo
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica chirurgica I, University of Padova, Via giustiniani 2, 35128, Padua, Italy. andreabarina1@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Barina
authors.affiliation: Epidemiological Service of the Veneto Region, Padua, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Gennaro
authors.affiliation: Surgical Unit - Local Health Unit n°4, Veneto Region, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rebonato
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica chirurgica I, University of Padova, Via giustiniani 2, 35128, Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Nitti
authors.affiliation: Epidemiological Service of the Veneto Region, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Saugo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Colorectal cancer; Reoperation rate; Surgical Unit volume