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Objective: To determine surgeon factors leading to higher quality, cost-effective care in colon cancer surgery.
Design: Administrative database analysis.
Setting: Hospitals participating in the UHC database.
Patients: Adult patients undergoing colectomy for colon cancer between 2008 and 2012.
Interventions: Colectomy by high-volume (HVS) vs. low-volume (LVS) surgeons as determined by distribution of surgeon volume, (>6 colectomies per year, and 1-6 per year respectively).
Main outcome measures: Laparoscopy, complications, length of stay, ICU admission, direct hospital cost, readmissions.
Results: 33,198 patients over age18 were identified for inclusion. 28,987 underwent resection by high-volume surgeons (HVS) and 4,211 by low-volume surgeons (LVS). HVS were more likely than LVS to perform the procedure using laparoscopy. Patients operated on by HVS had a lower 30-day readmission rate than LVS. LVS admitted patients to the ICU more often than HVS. Post-operative complications were higher in the LVS group. Mean length of stay in the HVS group was 9.1 days compared to 11.9 days in the LVS group. Mean direct cost was $4,900 lower in the HVS group. After adjustment for age, sex, race, insurance status, severity of illness, admission status, and procedure, HVS still had lower readmission rates, length of stay and mean cost and were more likely to perform the procedure using laparoscopy.
Conclusions: Surgeons who perform greater than 6 colectomies per year for colon cancer are more likely to use laparoscopy, less likely to admit patients to the ICU, have lower complication and readmission rates, and shorter LOS. Hospital cost is significantly lower in patients operated on by high volume surgeons.