title: Surgeon volume and 30 day mortality for brain tumours in England.
abstract: BACKGROUND
  There is evidence that surgeons who perform more operations have better outcomes. However, in patients with brain tumours, all of the evidence comes from the USA.
  
  
  METHODS
  We examined all English patients with an intracranial neoplasm who had an intracranial resection in 2008-2010. We included surgeons who performed at least six operations over 3 years, and at least one operation in the first and last 6 months of the period.
  
  
  RESULTS
  The analysis data set comprised 9194 operations, 163 consultant neurosurgeons and 30 centres. Individual surgeon volumes varied widely (7-272; median=46). 72% of operations were on the brain, and 30 day mortality was 3%. A doubling of surgeon load was associated with a 20% relative reduction in mortality. Thirty day mortality varied between centres (0·95-8·62%) but was not related to centre workload.
  
  
  CONCLUSIONS
  Individual surgeon volumes correlated with patient 30 day mortality. Centres and surgeons in England are busier than surgeons and centres in the USA. There is no relationship between centre volume and 30 day mortality in England. Services in the UK appear to be adequately arranged at a centre level, but would benefit from further surgeon sub-specialisation.
authors.affiliation: Department of Radiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.|Computational Oncology Laboratory, Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Imperial College, London SW7 2AZ, UK.
authors.forename: Matt
authors.initials: M
authors.lastname: Williams
authors.affiliation: National Cancer Registration and Analysis Service, Public Health England, Victoria House, Capital Park, Fulbourn, Cambridge CB21 5XA, UK.|Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge CB2 2SR, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Treasure
authors.affiliation: National Cancer Registration and Analysis Service, Public Health England, Victoria House, Capital Park, Fulbourn, Cambridge CB21 5XA, UK.
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brodbelt
authors.affiliation: Department of Pathology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged