Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study.

BACKGROUND American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.

• Publication year

  2020

• Venue

  Canadian journal of surgery. Journal canadien de chirurgie

• Publication date

  2020-09-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1503/cjs.012319PMID 33107818PMCID PMC7608709
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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  2010influential reference
• The effect of hospital and surgeon volume on outcomes for rectal cancer surgery.

  2008cited by this paper
• Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence Part 2: Long‐term outcome

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• Surgeon Volume and Operative Mortality in the United States.

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  2003cited by this paper
• Hospital volume and surgical mortality in the United States.

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• Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population

  2000cited by this paper
• Surgeon-related factors and outcome in rectal cancer.

  1999cited by this paper
• Surgeon-related factors and outcome in rectal cancer.

  1998cited by this paper

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