Key result
High hospital surgical volume was not significantly associated with a reduction in failure-to-rescue after severe complications of colorectal cancer surgery compared to low-volume centers (adjusted IRR 0.97).
Why the study?
Few studies have assessed the relationship between hospital surgical volume and failure-to-rescue after colon and rectal cancer surgery.
Does surgery at high-volume centers reduce failure-to-rescue in patients undergoing colorectal cancer surgery?
Cohort (n=23,351)
Yes
Does surgery at high-volume centers reduce failure-to-rescue in patients undergoing colorectal cancer surgery?
Relative Risk: 0.97 (95% CI 0.75–1.26)
Absolute Event Rate: 9.4% vs 9.7%
p-value: p=0.844
Hospital surgical volume is not significantly associated with failure-to-rescue after colorectal cancer surgery in Sweden.
BACKGROUND: The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. METHODS: Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien-Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50-150 cases/year) and high-volume centers (> 150 cases/year). RESULTS: A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75-1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80-5.31, p = 0.134) for high-volume centers and 2.15 (0.83-5.56, p = 0.116) for medium-volume centers in the second stratification. CONCLUSION: This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.
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Lillo‐Felipe et al. (2021) conducted a cohort in Colorectal cancer (n=23,351). High hospital surgical volume (≥200 cases/year) vs. Low hospital surgical volume (<200 cases/year) was evaluated on Failure-to-rescue (30-day mortality after severe postoperative complications) (IRR 0.97, 95% CI 0.75-1.26, p=0.844). High hospital surgical volume was not significantly associated with a reduction in failure-to-rescue after severe complications of colorectal cancer surgery compared to low-volume centers (adjusted IRR 0.97).
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