The association between provider volume and characteristics and patient outcomes in colorectal surgery

Numerous studies have described lower operative mortality rates at high volume hospitals with selected surgical procedures. Improved patient outcomes have also been associated higher surgeon volume and surgeon specialty training. Moreover, for cancer surgery, there is an inverse relationship between surgeon and hospital volume and late mortality. To evaluate the impact of surgeon and hospital characteristics on patient outcomes in colon and rectal surgery, we review studies examining the association between provider characteristic—hospital volume, surgeon volume, and surgeon board certification—and patient outcomes. In general, high hospital volume is associated with lower operative and late mortality rates for colon, but not rectal cancer resections. For both colon and rectal cancer surgery, several analyses suggest that high surgeon volume is a predictor of improved survival. The preponderance of evidence suggests that policies aimed at selectively referring patients to more experienced providers would have small but meaningful reductions in mortality.