M. A. Adam1, D. Becerra1, M. C. Turner1, C. R. Mantyh1, J. Migaly1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: The association between surgeon volume and improved outcomes for minimally invasive colectomy (MIC) has been established. However, a definition of a high-volume MIC surgeon remains unclear. We aimed to determine the number of MIC per surgeon per year that is associated with the lowest risk of postoperative complications.
Methods: Adult patients undergoing MIC were identified from the HCUP-National Inpatient Sample (2008-2009). Multivariabe logistic regression with restricted cubic splines was utilized to examine the association between the number of annual MIC/surgeon and risk of complications.
Results: 6554 patients were identified; 51% had a diagnosis of colon cancer. Overall, 20% experienced a postoperative complication and 0.5% died in hospital. Median surgeon volume was 10 cases/year. After adjustment for case and procedure mix, the likelihood of experiencing a complication decreased with increasing surgeon volume up to 20 MIC cases/year (p<0.01) (Figure). The vast majority of patients (70%) underwent surgery by low-volume (<20 cases/year). Patients treated by low volume surgeons were more likely to experience conversion to open colectomy (0.8% vs. 0.3%), postoperative complications (21% vs. 17%), prolonged hospital length of stay (6 vs. 5 days), and higher inflation-adjusted hospital costs ($12669 vs. $11752), (all p<0.01).
Conclusion: This study identifies a surgeon volume threshold (>20 cases/year) that is associated with improved patient outcomes from minimally invasive colectomy. Identifying a threshold number of cases defining a high-volume MIC surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.
