Impact of colorectal surgeon case volume on outcomes and applications to quality improvement

Yi, David; Monson, J. R. T.; Stankiewicz, Cathy C.; Atallah, S.; Finkler, Neil J.

doi:10.1007/s00384-018-3018-6

Cited by 14 publications

(12 citation statements)

References 14 publications

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“…Nowadays, surgical cost-effectiveness may be further improved by reducing operating time and the use of reusable instruments. Recently, Yi et al [18] evaluated the impact of the surgeon’s experience on the total cost of laparoscopic surgery. Surgeons in high-volume centers experience shorter operating times, lower hospitalization costs, and shorter LOS.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Surgeons in high-volume centers experience shorter operating times, lower hospitalization costs, and shorter LOS. They suggest that these benefits may outweigh the learning curve-associated costs tied to the skill acquisition of laparoscopic surgery [18]. Other studies have shown that the number of perioperative-related complications, morbidity, and mortality rates decreased with increasing experience of the surgeon performing laparoscopic surgery [19, 20].…”

Section: Discussion/conclusionmentioning

confidence: 99%

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The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

et al. 2020

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Introduction: Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. Methods: This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. Results: A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. Conclusion: During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Discussion/conclusionmentioning

confidence: 99%

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

et al. 2020

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“…However, when choosing inclusion criteria and building a search strategy, surgical access and type of surgery were not limited to either of the groups and we decided to follow the initial methodology. Additionally, we did not analyze other factors that might have had an impact on the final results: the surgeon’s experience, high vs. low inferior mesenteric artery ligation, or hospital volume [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Safety of Selective Use of Splenic Flexure Mobilization in Sigmoid and Rectal Resections—Systematic Review and Meta-Analysis

Nowakowski

Małczak

Mizera

et al. 2018

JCM

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Background: According to traditional textbooks on surgery, splenic flexure mobilization is suggested as a mandatory part of open rectal resection. However, its use in minimally invasive access seems to be limited. This stage of the procedure is considered difficult in the laparoscopic approach. The aim of this study was to systematically review literature on flexure mobilization and perform meta-analysis. Methods: A systematic review of the literature was performed using the Medline, Embase and Scopus databases to identify all eligible studies that compared patients undergoing rectal or sigmoid resection with or without splenic flexure mobilization. Inclusion criteria: (1) comparison of groups of patients with and without mobilization and (2) reports on overall morbidity, anastomotic leakage, operative time, length of specimen, number of harvested lymph nodes, or length of hospital stay. The outcomes of interest were: operative time, conversion rate, number of lymph nodes harvested, overall morbidity, mortality, leakage rate, reoperation rate, and length of stay. Results: Initial search yielded 2282 studies. In the end, we included 10 studies in the meta-analysis. Splenic flexure is associated with longer operative time (95% confidence interval (CI) 23.61–41.25; p < 0.001) and higher rate of anastomotic leakage (risk ratios (RR): 1.02; 95% CI 1.10–3.35; p = 0.02), however the length of hospital stay is shorter by 0.42 days. There were no differences in remaining outcomes. Conclusions: Not mobilizing the splenic flexure results in a significantly shorter operative time and a longer length of stay. Further research is required to establish whether flexure mobilization is required in minimally invasive surgery.

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“…Similarly, an Irish study investigating LOS among emergency colorectal surgery admissions found total LOS to be significantly shorter among patients admitted to higher volume hospitals, who were older and with co-morbidities [17]. A study evaluating the impact of surgeon volume, reported total LOS to be 1.3 days shorter among high-volume surgeons and post-operative LOS reduced by 0.92 days, when high volume surgeons were compared to low volume surgeons [18].…”

Section: Introductionmentioning

confidence: 97%

Variation in Hospital Length of Stay Based on Hospital Volume: A Retrospective Cohort Study of Emergency Abdominal Surgery in Ireland

Kavanagh¹,

Nally²,

Valentelyte³

et al. 2019

SCR

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Objectives: Emergency abdominal surgery (EAS) refers to high risk intra-abdominal surgical procedures associated with increased mortality risk and long length of hospital stay. The variation between hospital volume and hospital length of stay (LOS) of patients undergoing EAS is poorly understood. Our objective was to explore this relationship across public hospitals in Ireland. Methods: Data for all adult episode discharges from public Irish hospitals in 2014-2017 were obtained from National Quality Assurance Improvement System (NQAIS) Clinical with EAS identified by primary procedure codes. Hospitals were categorised into low (n<200), medium (n=200-400), and high (n>400) volume groups based on the number of EAS episodes during the study period. Negative binomial regression models were applied to standardise for patient case mix. Several adjusted LOS measures were compared across the three volume groups. Sensitivity analysis was conducted to test the robustness of our findings. Results: 8120 hospital episodes across 24 public hospitals providing EAS services were analysed. 7 were categorised as low, 9 as medium, and 8 as high-volume hospitals. High volume hospitals had a significantly longer adjusted LOS (24.7 days) relative to low and medium volume hospitals (18.2 and 18.6 days). Sensitivity analysis consisted of the exclusion of the following hospital episodes: in-hospital death, cancer diagnosis, Charlson comorbidity index (CCI) >0, admission from other hospitals, and discharge to other hospitals. No single variable influenced the observed LOS variation, although when the more complex episodes were excluded, the post-operative LOS at low and medium volume hospitals was significantly shorter compared to high volume hospitals (by 1.1-6.1 days). Intensive care unit (ICU) LOS was similar in all three hospital volume groups although low volume hospitals appeared to have more ICU admissions and longer stay (by up to 1.6 days). Conclusions: Our findings indicate that patients treated at low volume hospitals have shorter LOS and may be discharged earlier than from high volume hospitals. This finding is surprising, suggesting that concentration of services to larger clinical departments may not necessarily reduce LOS and improve the efficiency of resource utilisation and service delivery.

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Impact of colorectal surgeon case volume on outcomes and applications to quality improvement

Abstract: 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.

Cited by 14 publications

References 14 publications

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

The Safety of Selective Use of Splenic Flexure Mobilization in Sigmoid and Rectal Resections—Systematic Review and Meta-Analysis

Variation in Hospital Length of Stay Based on Hospital Volume: A Retrospective Cohort Study of Emergency Abdominal Surgery in Ireland

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