title: Impact of hospital volume on quality indicators for rectal cancer surgery in British Columbia, Canada.
abstract: BACKGROUND
  The relationship between hospital volume and patient outcomes remains controversial for rectal cancer.
  
  
  METHODS
  This is a population-based database study. Patients treated with surgery for a stage I to III rectal adenocarcinoma from 2003 to 2009 were identified. High-volume hospitals (HVH) were those centers performing 20 surgeries or more per year. Primary outcomes were operative and perioperative factors that have proven influence on patient outcomes.
  
  
  RESULTS
  In all, 2,081 patients had surgery for rectal cancer. Of these, 1,690 patients had surgery in an HVH and 391 had surgery in a low-volume hospital. On multivariate analysis, patients who had surgery in an HVH were more likely to have sphincter-preserving surgery, 12 or more lymph nodes removed with the tumor, neoadjuvant radiation therapy, and receive pre-operative or postoperative chemotherapy.
  
  
  CONCLUSIONS
  For rectal cancer patients in British Columbia, Canada, being treated at an HVH is associated with several quality indicators linked to better patient outcomes.
authors: Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Ryan J
authors: RJ
authors: McColl
authors: Surgical Oncology Network, Cancer Surveillance and Outcomes, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors: Colleen E
authors: CE
authors: McGahan
authors: Surgical Oncology Network, Cancer Surveillance and Outcomes, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors: Eric
authors: E
authors: Cai
authors: Radiation Therapy Program, British Columbia Cancer Agency, Prince George, British Columbia, Canada.
authors: Rob
authors: R
authors: Olson
authors: Systemic Therapy Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors: Winson Y
authors: WY
authors: Cheung
authors: Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Manoj J
authors: MJ
authors: Raval
authors: Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Paul Terry
authors: PT
authors: Phang
authors: Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Ahmer A
authors: AA
authors: Karimuddin
authors: Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Room C310, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. Electronic address: cbrown@providencehealth.bc.ca.
authors: Carl J
authors: CJ
authors: Brown
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D001003:Anal Canal; D001955:British Columbia / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012042:Registries
keywords: Hospital volume; Oncologic; Outcomes; Quality indicators; Quality of life; Rectal cancer