title: Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project.
abstract: INTRODUCCIóN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons.
  
  
  METHODS
  Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥36 procedures per year).
  
  
  RESULTS
  After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI95% 5.6-7.6), 20.3 (CI95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI95% 1.071-1,333]), local recurrence (MHR 1.308 [CI95% 1.010-1.668]) and metastases (MHR 1.300 [CI95% 1.181; 1.476]) between all hospitals.
  
  
  CONCLUSIONS
  Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients. However, local recurrence was not influenced by caseload.
authors.affiliation: Departamento Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España. Electronic address: hhortiz@telefonica.net.
authors.forename: Héctor
authors.initials: H
authors.lastname: Ortiz
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Josep Trueta, Girona, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Codina
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España.
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: Ciga
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario de Bellvitge, Barcelona, España.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Biondo
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Donostia, Donostia, España.
authors.forename: José M
authors.initials: JM
authors.lastname: Enríquez-Navascués
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Vall D'Hebron, Barcelona, España.
authors.forename: Eloy
authors.initials: E
authors.lastname: Espín
authors.affiliation: Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario La Fe, Valencia, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Granero
authors.affiliation: Unidad de Coloproctología. Hospital Nisa 9 de Octubre, Valencia, España.
authors.forename: José V
authors.initials: JV
authors.lastname: Roig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000592:standards; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
keywords: Case-load; Comparación de hospitales; Comparison of departments; Cáncer de recto; Educación médica; Education; Local recurrence; Overall survival; Recidiva local; Rectal cancer; Supervivencia global; Volumen quirúrgico anual