This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (196)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Oncology  • Colon Cancer  • Surgery  • Surgical Interventions  • Gastrointestinal/ Upper Foregut  • Thoracic Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

Deborah Schrag, MD; Laura D. Cramer, ScM; Peter B. Bach, MD; Alfred M. Cohen, MD; Joan L. Warren, PhD; Colin B. Begg, PhD

JAMA. 2000;284:3028-3035.

Context  Survival following high-risk cancer surgery, such as pancreatectomy and esophagectomy, is superior at hospitals where high volumes of these procedures are performed. Conflicting evidence exists as to whether the association between hospital experience and favorable health outcomes also applies to more frequently performed operations, such as those for colon cancer.

Objective  To determine whether hospital procedure volume predicts survival following colon cancer surgery.

Design, Setting, and Participants  Retrospective cohort study of data from the Surveillance, Epidemiology and End Results–Medicare linked database on 27 986 colon cancer patients aged 65 years and older who had surgical resection for primary adenocarcinoma diagnosed between 1991 and 1996.

Main Outcome Measures  Thirty-day postoperative mortality and overall and cancer-specific long-term survival, by hospital procedure volume.

Results  We found small differences in 30-day postoperative mortality for patients treated at low- vs high-volume hospitals (3.5% at hospitals in the top-volume quartile vs 5.5% at hospitals in the bottom-volume quartile). However, the correlation was statistically significant and persisted after adjusting for age at diagnosis, sex, race, cancer stage, comorbid illness, socioeconomic status, and acuity of hospitalization (P<.001). The association was evident for subgroups with stage I, II, and III disease. Hospital volume directly correlated with survival beyond 30 days and also was not attributable to differences in case mix (P<.001). The association between hospital volume and long-term survival was concentrated among patients with stage II and III disease (P<.001 for both). Among stage III patients, variation in use of adjuvant chemotherapy did not explain this finding.

Conclusion  Our data suggest that hospital procedure volume predicts clinical outcomes following surgery for colon cancer, although the absolute magnitudes of these differences are modest in comparison with the variation observed for higher-risk cancer surgeries.

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs Schrag, Bach, and Begg and Ms Cramer), Medicine (Drs Schrag and Bach), and Surgery (Dr Cohen), Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, New York, NY; and the Applied Research Branch, National Cancer Institute (Dr Warren).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

December 20, 2000
JAMA. 2000;284(23):3067-3068.
EXTRACT | FULL TEXT  

Colon Cancer
JAMA. 2000;284(23):3086.
PDF  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Large age and hospital-dependent variation in administration of adjuvant chemotherapy for stage III colon cancer in southern Netherlands
van Steenbergen et al.
Ann Oncol 2009;0:mdp482v1-mdp482.
ABSTRACT | FULL TEXT  

Centralization of Cancer Surgery: Implications for Patient Access to Optimal Care
Stitzenberg et al.
JCO 2009;27:4671-4678.
ABSTRACT | FULL TEXT  

Centralization of Cancer Surgery: What Does It Mean for Surgical Training?
Greenberg et al.
JCO 2009;27:4637-4639.
FULL TEXT  

Quality Wrapped in Volume Inside a Hospital
Bach
ANN INTERN MED 2009;150:729-730.
FULL TEXT  

The Effect of Provider Case Volume on Cancer Mortality: Systematic Review and Meta-Analysis
Gruen et al.
CA Cancer J Clin 2009;59:192-211.
ABSTRACT | FULL TEXT  

Underuse of Esophagectomy as Treatment for Resectable Esophageal Cancer
Paulson et al.
Arch Surg 2008;143:1198-1203.
ABSTRACT | FULL TEXT  

Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card
Bilimoria et al.
JNCI J Natl Cancer Inst 2008;100:1310-1317.
ABSTRACT | FULL TEXT  

Use and Outcomes of Laparoscopic-Assisted Colectomy for Cancer in the United States
Bilimoria et al.
Arch Surg 2008;143:832-840.
ABSTRACT | FULL TEXT  

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival
Le et al.
Cancer Epidemiol. Biomarkers Prev. 2008;17:1950-1962.
ABSTRACT | FULL TEXT  

D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer
Sasako et al.
NEJM 2008;359:453-462.
ABSTRACT | FULL TEXT  

Association of Demographic and Treatment Variables in Long-Term Colon Cancer Survival
Lincourt et al.
SURG INNOV 2008;15:17-25.
ABSTRACT  

Hospital Lymph Node Examination Rates and Survival After Resection for Colon Cancer
Wong et al.
JAMA 2007;298:2149-2154.
ABSTRACT | FULL TEXT  

Misclassification of Hospital Volume With Surveillance, Epidemiology, and End Results Medicare Data
Hollenbeck et al.
SURG INNOV 2007;14:192-198.
ABSTRACT  

Administrative data outperformed single-day chart review for comorbidity measure
Luthi et al.
Int J Qual Health Care 2007;19:225-231.
ABSTRACT | FULL TEXT  

Adjuvant Treatment of Colorectal Cancer
Wolpin et al.
CA Cancer J Clin 2007;57:168-185.
ABSTRACT | FULL TEXT  

Impact of Surgeon and Hospital Caseload on the Likelihood of Performing Laparoscopic vs Open Sigmoid Resection for Diverticular Disease: A Study Based on 55 949 Patients
Weber et al.
Arch Surg 2007;142:253-259.
ABSTRACT | FULL TEXT  

Patient characteristics and hospital quality for colorectal cancer surgery
Zhang et al.
Int J Qual Health Care 2007;19:11-20.
ABSTRACT | FULL TEXT  

Association Between Venous Thromboembolism and Perioperative Allogeneic Transfusion
Nilsson et al.
Arch Surg 2007;142:126-132.
ABSTRACT | FULL TEXT  

Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer Surgery: Understanding the Volume-Outcome Relationship
Billingsley et al.
Arch Surg 2007;142:23-31.
ABSTRACT | FULL TEXT  

Disparities in the utilization of high-volume hospitals for complex surgery.
Liu et al.
JAMA 2006;296:1973-1980.
ABSTRACT | FULL TEXT  

Physical Activity and Survival After Colorectal Cancer Diagnosis
Meyerhardt et al.
JCO 2006;24:3527-3534.
ABSTRACT | FULL TEXT  

Colorectal Cancer Model of Health Disparities: Understanding Mortality Differences in Minority Populations
Polite et al.
JCO 2006;24:2179-2187.
ABSTRACT | FULL TEXT  

Completion of therapy by Medicare patients with stage III colon cancer.
Dobie et al.
JNCI J Natl Cancer Inst 2006;98:610-619.
ABSTRACT | FULL TEXT  

Transcending the Volume-Outcome Relationship in Cancer Care
Lipscomb
JNCI J Natl Cancer Inst 2006;98:151-154.
FULL TEXT  

Associations Between Hospital and Surgeon Procedure Volumes and Patient Outcomes After Ovarian Cancer Resection
Schrag et al.
JNCI J Natl Cancer Inst 2006;98:163-171.
ABSTRACT | FULL TEXT  

The Relation Between Patients' Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries
Al-Khatib et al.
J Am Coll Cardiol 2005;46:1536-1540.
ABSTRACT | FULL TEXT  

Racial Disparities in Treatment and Survival Among Women With Early-Stage Breast Cancer
Hershman et al.
JCO 2005;23:6639-6646.
ABSTRACT | FULL TEXT  

Population-Based Assessment of Surgical Treatment Trends for Patients With Melanoma in the Era of Sentinel Lymph Node Biopsy
Cormier et al.
JCO 2005;23:6054-6062.
ABSTRACT | FULL TEXT  

Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery
Ciccolallo et al.
Gut 2005;54:268-273.
ABSTRACT | FULL TEXT  

Adjuvant therapy for stage II colon cancer: an elephant in the living room?
Zaniboni and Labianca
Ann Oncol 2004;15:1310-1318.
ABSTRACT | FULL TEXT  

Developing a System to Assess the Quality of Cancer Care: ASCO's National Initiative on Cancer Care Quality
Schneider et al.
JCO 2004;22:2985-2991.
FULL TEXT  

Understanding Cancer Treatment and Outcomes: The Cancer Care Outcomes Research and Surveillance Consortium
Ayanian et al.
JCO 2004;22:2992-2996.
FULL TEXT  

Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study
Meyerhardt et al.
JCO 2004;22:166-174.
ABSTRACT | FULL TEXT  

Racial Differences in Mortality Among Medicare Recipients After Treatment for Localized Prostate Cancer
Godley et al.
JNCI J Natl Cancer Inst 2003;95:1702-1710.
ABSTRACT | FULL TEXT  

Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence
Meyerhardt et al.
ANN INTERN MED 2003;139:649-657.
ABSTRACT | FULL TEXT  

The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes
Panageas et al.
ANN INTERN MED 2003;139:658-665.
ABSTRACT | FULL TEXT  

Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume
Marrie et al.
Eur Respir J 2003;22:148-155.
ABSTRACT | FULL TEXT  

Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization
Urbach et al.
CMAJ 2003;168:1409-1414.
ABSTRACT | FULL TEXT  

Relation of Hospital Volume to Colostomy Rates and Survival for Patients With Rectal Cancer
Hodgson et al.
JNCI J Natl Cancer Inst 2003;95:708-716.
ABSTRACT | FULL TEXT  

Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort
Ayanian et al.
JCO 2003;21:1293-1300.
ABSTRACT | FULL TEXT  

Taking Stock of Volume-Outcome Studies
Begg and Scardino
JCO 2003;21:393-394.
FULL TEXT  

Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
Halm et al.
ANN INTERN MED 2002;137:511-520.
ABSTRACT | FULL TEXT  

Does delivery volume of family physicians predict maternal and newborn outcome?
Klein et al.
CMAJ 2002;166:1257-1263.
ABSTRACT | FULL TEXT  

Variations in Morbidity after Radical Prostatectomy
Begg et al.
NEJM 2002;346:1138-1144.
ABSTRACT | FULL TEXT  

The Vermont Colorectal Cancer Project: Self-portrait
Hyman et al.
Arch Surg 2002;137:413-416.
ABSTRACT | FULL TEXT  

Hidden Barriers to Improvement in the Quality of Care
McNeil
NEJM 2001;345:1612-1620.
FULL TEXT  

The Influence of Hospital Volume on Survival after Resection for Lung Cancer
Bach et al.
NEJM 2001;345:181-188.
ABSTRACT | FULL TEXT  

Impact of Patient and Provider Characteristics on the Treatment and Outcomes of Colorectal Cancer
Hodgson et al.
JNCI J Natl Cancer Inst 2001;93:501-515.
ABSTRACT | FULL TEXT  

Hospital Procedure Volume and Outcome of Colon Cancer Surgery
JWatch Gastroenterology 2001;2001:1-1.
FULL TEXT