International Journal of Colorectal Disease

, Volume 34, Issue 12, pp 2121–2127 | Cite as

Does it matter where you get your surgery for colorectal cancer?

  • Mohammad Hamidi
  • Kamil Hanna
  • Pamela Omesiete
  • Alejandro Cruz
  • Agnes Ewongwo
  • Viraj Pandit
  • Bellal Joseph
  • Valentine NfonsamEmail author
Original Article



The influence of hospital-related factors on outcomes following colorectal surgery is not well-established. The aim of our study was to evaluate the relationship between hospital factors on outcomes in surgically managed colorectal cancer patients.


We performed a 2-year (2014–2015) analysis of the NIS database. Adult (> 18 years) patients who underwent open or laparoscopic colorectal resection were identified using ICD-9 codes. Patients were stratified based on hospital: volume (low vs. high), teaching status, and location (urban vs. rural). Outcome measures were complications and mortality. Multivariate logistic regression was performed.


A total of 153,453 patients with CRC were identified of which 35.3% underwent surgical management. Mean age was 69 ± 13 years, 51.6% were female, and 67% were white. Twenty-seven percent of the patients were managed at a high-volume center, 48% at intermediate-volume center while 25% at a low-volume center. Complications and mortality rates were lower in patients who were managed at high-volume centers and urban hospitals, while no difference was noticed based on teaching status. On regression analysis, patients managed at high-volume centers (OR 0.76 [0.56–0.89]) and urban hospitals (OR 0.83 [0.64–0.91]) have lower odds of complications; similarly, high-volume centers (OR 0.79 [0.65–0.90]) and urban facility (OR 0.87 [0.70–0.92]) were associated with lower odds of mortality. However, there was no association between teaching status and outcomes.


Hospital factors significantly influence outcomes in patients with CRC managed surgically. High-volume centers and urban facilities have relatively better outcomes. Regionalization of care along with the appropriate availability of resources may improve outcomes in patients with CRC.

Level of evidence

Level III, Retrospective Observational Study


Colorectal cancer Hospital volume Urban Rural Teaching hospital 


Author contributions

Study design and conception: VN, MH, KH, AE, BJ, VP

Data acquisition: AC, VN, KH, MH, PO

Statistical analysis: PO, VN, KH, MH

Manuscript writing: AE, MH, KH, VN, VP

Critical revision: AC, VN, KH, MH, PO, VP, BJ

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Arizona Medical CenterTucsonUSA

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