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Abstract
Colorectal cancer (CRC) patients who receive cancer surgeries from higher-volume providers may have better outcomes. However, the definitions of surgical volume may affect the results. We aim to analyze the effects of different definitions of surgical volume on patient outcomes. We conducted a nationwide population-based study in Taiwan that enrolled all patients who underwent definitive surgery for newly diagnosed CRC. We used three common definitions of surgical volume: total volume means the total surgical number conducted by the same provider during the study period; cumulative volume was calculated as the number of operations the surgeon performed before the index procedure; annual volume was calculated as the number of times the surgeon had been responsible for surgery during the index year. In this study, we included 100,009 newly diagnosed CRC patients, including 55.8% males, of median age 66 years at diagnosis (range 20–105 years). After adjustment for the patient and provider characteristics, we found that CRC patients receiving definitive surgery by higher-volume providers had better outcomes, especially where surgeon volume may play a more important role than hospital volume. The cumulative volume could predict the 5-year mortality of the study cohort better than the total and annual volume.
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1 Taipei Veterans General Hospital, Division of Transfusion Medicine, Department of Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Yang Ming Chiao Tung University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
2 National Yang Ming Chiao Tung University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Taipei Veterans General Hospital, Division of Radiation Oncology, Department of Oncology, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Yang-Ming University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
3 National Yang Ming Chiao Tung University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); National Yang-Ming University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Division of Hematology and Oncology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (GRID:grid.414746.4) (ISNI:0000 0004 0604 4784)
4 National Yang Ming Chiao Tung University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); National Yang Ming Chiao Tung University, Institute of Hospital and Health Care Administration, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
5 Taipei Veterans General Hospital, Division of Transfusion Medicine, Department of Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Yang-Ming University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); National Yang Ming Chiao Tung University, Institute of Emergency and Critical Care Medicine, Hsinchu, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)