Impact of colorectal surgeon case volume on outcomes and applications to quality improvement
To evaluate the impact of surgeon case volumes on procedural, financial, and clinical outcomes in colorectal surgery and apply findings to improve hospital care quality.
A retrospective review was performed using 2013–2014 administrative data from a large hospital system in Southeast U.S. region; univariate and multivariable regression analyses were used to explore the impact of surgeon case volume on outcomes.
One thousand one hundred ninety patients were included in this 2-year study. When compared with low-volume surgeons (LVS) (< 14 cases in 2 years), the high-volume surgeons (HVS) (> 34 cases) were estimated per case to have shorter cut-to-close time in the operation room by 79 min, ([95% CI 58 to 99]), lower total hospitalization cost by $4314, ([95% CI $2261 to $6367]), and shorter post-surgery and overall length of stay by 0.92 days, ([95% CI 0.50 to 1.35]) and 1.27 days ([95% CI 0.56 to 1.98]), respectively. The HVS also showed a higher tendency to choose a laparoscopic approach over an open approach, with an odds ratio of 3.16 ([95% CI 1.23 to 8.07]). When compared with medium-volume surgeons (MVS) (14–34 cases), the HVS were estimated per case to have shorter cut-to-close time in the operation room by 62 min ([95% CI 37 to 87]). Surgeon case volumes had no statistically significant impact on outcomes including in-hospital mortality, 30-day readmission, blood utilization, and surgical site infection (SSI).
Surgeon case volume had positive impacts on procedural, financial, and clinical outcomes and this finding may be used to improve hospital’s quality of care.
KeywordsColorectal surgery Case volume Outcomes Quality improvement
The authors thank Lawrence Lee, MD, Xiang Zhu, MS, and Penny Carlson, MS, for reviewing and providing critique to the manuscript.
- 1.Delaney C, Kiran R, Senagore A. (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1)Google Scholar
- 3.Etzioni D, Young-Fadok T. (2014) Patient survival after surgical treatment of rectal cancer. CancerGoogle Scholar
- 6.Archampong D, Borowski D (2012) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. The Cochrane Library, Issue 3Google Scholar
- 8.Damle R, Macomber C (2014) Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg 218(6)Google Scholar
- 9.ICD-9 Provider and Diagnostic Codes (2015) http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes.html Accessed Dec 28
- 10.Adler L, Yi D, Li M, et al (2015) Impact of inpatient harms on hospital finances and patient clinical outcomes. J Patient Saf. Published Ahead-of-print, Volume 00, Number 00Google Scholar
- 12.Klein-Geltink JE, Rochon PA, Dyer S et al (2007) Readers should systematically assess methods used to identify, measure and analyze confounding in observational cohort studies. J Clin Epidemiol 60Google Scholar
- 13.Romano P, Chan B (2000) Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? HSR: Health Serv Res 34:7Google Scholar
- 14.Sonnberger H (1989) Regression diagnostics: identifying influential data and sources of collinearity, by D. A. Belsley, K. Kuh and R. E. Welsch. (John Wiley & Sons, New York, 1980, pp. xv + 292, ISBN 0-471-05856-4), J Appl Econ, 4:97–99. https://doi.org/10.1002/jae.3950040108
- 16.Cameron AC, Trivedi PK (2010) Microeconometrics using stata. Rev. ed. Stata Press, College Station, TXGoogle Scholar
- 17.Guo S, Fraser MW (2015) Propensity score analysis: statistical methods and applications, 2nd edn. Sage, Thousand OaksGoogle Scholar
- 19.Centers for Medicare and Medicaid Services (2013) Hospital value-based purchasing [Internet]. Baltimore (MD): CMS; Aug 9 [cited 2015 Jan 26]. Available from: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-basedpurchasing/index.html?redirect=/hospital-value-based-purchasing
- 20.Centers for Medicare and Medicaid Services (2013) Hospital value-based purchasing program [Internet]. Baltimore (MD): CMS; Mar [cited 2015 Jan 26]. Available from: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf
- 21.Rau J (2012) Medicare discloses hospitals’ bonuses, penalties based on quality. Kaiser Health News [serial on the Internet]. Dec 20 [cited 2015 Jan 26]. Available from: http://www.kaiserhealthnews.org/stories/2012/december/21/medicarehospitals-value-based-purchasing.aspx