The impact of hospital volume on surgical outcome in patients with rectal cancer

Dis Colon Rectum. 2009 Sep;52(9):1542-9. doi: 10.1007/DCR.0b013e3181af58f4.


Purpose: This study was designed to investigate, in a population-based setting, the surgical outcome in patients with rectal cancer according to the hospital volume.

Methods: Since 1995 all patients with rectal cancer have been registered in the Swedish Rectal Cancer Registry. Hospitals were classified, according to number treated per year, as low-volume, intermediate-volume, or high-volume hospitals (<11, 11-25, or >25 procedures per year). Postoperative mortality, reoperation rate within 30 days, local recurrence rate, and overall five-year survival were studied. For postoperative morbidity and mortality the whole cohort from 1995 to 2003 (n = 10,425) was used. For cancer-related outcome only, those with five-year follow-ups, from 1995 to 1998, were used (n = 4,355).

Results: In this registry setting the postoperative mortality rate was 3.6% in low-volume hospitals, and 2.2% in intermediate-volume and high-volume hospitals (P = 0.002). The reoperation rate was 10%, with no differences according to volume. The overall local recurrence rates were 9.4%, 9.3%, and 7.5%, respectively (P = 0.06). Significant difference was found among the nonirradiated patients (P = 0.004), but not among the irradiated patients (P = 0.45). No differences were found according to volume in the absolute five-year survival.

Conclusion: Postoperative mortality and local recurrence in nonirradiated patients were lower in high-volume hospitals. No difference was seen between volumes in reoperation rates, overall local recurrence, or absolute five-year survival.

MeSH terms

  • Aged
  • Cohort Studies
  • Digestive System Surgical Procedures / statistics & numerical data*
  • Female
  • Health Facility Size
  • Humans
  • Male
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / surgery*
  • Registries
  • Retrospective Studies
  • Survival Analysis
  • Sweden / epidemiology
  • Treatment Outcome
  • Workload*