Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study

Abstract

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

“…Although there were no major differences in perioperative care and patient recovery after elective colonic surgery between European and US patients [22], postoperative length of stay was only 7 days in the United States but 10–13 days in European countries. In Germany, the postoperative hospital stay after colonic cancer surgery is as long as 17 days [24], and even patients undergoing laparoscopic colonic resection remain in hospital for 11–12 days after surgery [25]. Factors other than patient recovery which are responsible for the traditionally prolonged stay in German hospitals include: the reimbursement system hardly ever penalizes postoperative hospital stay; general practitioners are reluctant to treat patients who are discharged early after surgery; many hospitals do not have adequate outpatient facilities to take care of these patients; surgeons fear major complications after discharge (e.g.…”

Evaluation of quality indicators following implementation of total mesorectal excision in primarily resected rectal cancer changed future management

“…They showed that "medium-volume" surgeons achieved excellent outcomes similar to "high-volume" surgeons when operating in "medium-volume" or "highvolume" hospitals, while the results of "low-volume" surgeons improved with increasing hospital volume but never reached those of the "high-volume" surgeons [6]. In contrast, Marusch et al [7] failed to show significant associations between hospital caseload and postoperative outcome in 2,293 colorectal cancer patients undergoing surgery.…”

Prospektive Multizenterstudien “Kolon-/Rektumkarzinome” als flächendeckende chirurgische Qualitätssicherung

“…Auf die statistische Auswertung wichtiger Einzelaspekte und Outcome-Kriterien wurde verzichtet [17,18,19].…”