Impact of hospital volume on quality indicators for rectal cancer surgery in British Columbia, Canada

Am J Surg. 2017 Feb;213(2):388-394. doi: 10.1016/j.amjsurg.2016.07.007. Epub 2016 Aug 4.

Abstract

Background: The relationship between hospital volume and patient outcomes remains controversial for rectal cancer.

Methods: This is a population-based database study. Patients treated with surgery for a stage I to III rectal adenocarcinoma from 2003 to 2009 were identified. High-volume hospitals (HVH) were those centers performing 20 surgeries or more per year. Primary outcomes were operative and perioperative factors that have proven influence on patient outcomes.

Results: In all, 2,081 patients had surgery for rectal cancer. Of these, 1,690 patients had surgery in an HVH and 391 had surgery in a low-volume hospital. On multivariate analysis, patients who had surgery in an HVH were more likely to have sphincter-preserving surgery, 12 or more lymph nodes removed with the tumor, neoadjuvant radiation therapy, and receive pre-operative or postoperative chemotherapy.

Conclusions: For rectal cancer patients in British Columbia, Canada, being treated at an HVH is associated with several quality indicators linked to better patient outcomes.

Keywords: Hospital volume; Oncologic; Outcomes; Quality indicators; Quality of life; Rectal cancer.

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / therapy*
  • Aged
  • Anal Canal
  • British Columbia / epidemiology
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Female
  • Hospitals, High-Volume*
  • Hospitals, Low-Volume*
  • Humans
  • Lymph Node Excision / statistics & numerical data
  • Male
  • Multivariate Analysis
  • Neoadjuvant Therapy / statistics & numerical data
  • Organ Sparing Treatments / statistics & numerical data
  • Quality Indicators, Health Care*
  • Rectal Neoplasms / epidemiology
  • Rectal Neoplasms / therapy*
  • Registries