Rapid review
Patient volume and quality of care for colon cancer surgery
Report
|Updated
Update of our previous systematic review on patient volume and quality of care to assess new publications for colon cancer.
Key message
The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new publications for colon cancer.
We searched for publications in Medline for the period January 2006 to September 2008, which extends our previous search to cover the period back to 1990. We included studies that assessed the impact of hospital or surgeon volume on outcomes such as survival, mortality, complications or quality of life.
We identified 11 new studies and 1 relevant study from the 2001 report, altogether 12 relevant studies. Most studies were based on analyses of administrative databases and covered a period before year 2000. 11 of 12 studies addressed open surgery, and one study laparoscopic approach. There were some overlapping publications, due to multiple publications from the same databases.
The overall quality of the documentation is low and the results must be interpreted with caution.
- Five year survival was better in high volume hospitals.
- Mortality in hospital or within 30 days was around 3-5% in these studies, and significant lower for high volume hospitals and surgeons.
- One study addressed laparoscopic surgery, and found no association between hospital volume and survival or in hospital mortality.
- The thresholds for defining high and low volumes vary, and there is no com-mon definition. Low volume hospitals were below 10-30 annual procedures, while high hospital volume ranged from 29 to 138 procedures per year. The same was seen for surgeon volume. Low surgeon volume was set at below 2 - 7 annual procedures, and high surgeon volume between 6,5 to more than 20 annual procedures.
In Norway the surgical volume for colon cancer has been stable over the period from 2003-7, but has been centralised to fewer hospitals. Median annual volume per hospital was 27 in 2003 and 48 in 2007.