1
|
Schuld GJ, Schlager L, Monschein M, Riss S, Bergmann M, Razek P, Stift A, Unger LW. Does surgeon or hospital volume influence outcome in dedicated colorectal units?-A Viennese perspective. Wien Klin Wochenschr 2024:10.1007/s00508-024-02405-6. [PMID: 39093419 DOI: 10.1007/s00508-024-02405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/30/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE A clear relationship between higher surgeon volume and improved outcomes has not been convincingly established in rectal cancer surgery. The aim of this study was to evaluate the impact of individual surgeon's caseload and hospital volume on perioperative outcome. METHODS We retrospectively analyzed 336 consecutive patients undergoing oncological resection for rectal cancer at two Viennese hospitals between 1 January 2015 and 31 December 2020. The effect of baseline characteristics as well as surgeons' caseloads (low volume: 0-5 cases per year, high volume > 5 cases per year) on postoperative complication rates (Clavien-Dindo Classification groups of < 3 and ≥ 3) were evaluated. RESULTS No differences in baseline characteristics were found between centers in terms of sex, smoking status, or comorbidities of patients. Interestingly, only 14.7% of surgeons met the criteria to be classified as high-volume surgeons, while accounting for 66.3% of all operations. There was a significant difference in outcomes depending on the treating center in univariate and multivariate binary logistic regression analysis (odds ratio (OR) = 2.403, p = 0.008). Open surgery was associated with lower complication rates than minimally invasive approaches in univariate analysis (OR = 0.417, p = 0.003, 95%CI = 0.232-0.739) but not multivariate analysis. This indicated that the center's policy rather than surgeon volume or mode of surgery impact on postoperative outcomes. CONCLUSION Treating center standards impacted on outcome, while individual caseload of surgeons or mode of surgery did not independently affect complication rates in this analysis. The majority of rectal cancer resections are performed by a small number of surgeons in Viennese hospitals.
Collapse
Affiliation(s)
- Gabor J Schuld
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lukas Schlager
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Matthias Monschein
- Hospital Floridsdorf, Department of General Surgery, Brünner Straße 68, 1221, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Bergmann
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Razek
- Hospital Floridsdorf, Department of General Surgery, Brünner Straße 68, 1221, Vienna, Austria
| | - Anton Stift
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lukas W Unger
- Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
2
|
Bouchard-Fortier G, Gien LT, Sutradhar R, Chan WC, Krzyzanowska MK, Liu S(L, Ferguson SE. Impact of care by gynecologic oncologists on primary ovarian cancer survival: A population-based study. Gynecol Oncol 2022; 164:522-528. [DOI: 10.1016/j.ygyno.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
|
3
|
Nica A, Sutradhar R, Kupets R, Covens A, Vicus D, Li Q, Ferguson SE, Gien LT. Pre-operative wait times in high-grade non-endometrioid endometrial cancer: Do surgical delays impact patient survival? Gynecol Oncol 2021; 164:333-340. [PMID: 34895897 DOI: 10.1016/j.ygyno.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Practice guidelines advocating for regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were published in Ontario in June 2013. Our objectives were to determine whether this policy affected surgical wait times, and whether longer wait time to surgery is a predictor of survival in high grade endometrial cancer patients. METHODS This was a population-based retrospective cohort study, which included patients diagnosed with high-grade non-endometrioid endometrial cancer who had a hysterectomy between 2003 and 2017. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between surgical wait time and overall survival (OS). RESULTS We identified 3518 patients who underwent hysterectomy for high-grade non-endometrioid endometrial cancer. Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 53 days compared to 57 days pre-regionalization (p = 0.0007), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p = 0.0006). Survival was inferior for patients who had surgery within 14 days of diagnosis (HR death 2.7 for 1-7 days, 95% CI 1.61-4.51, and HR death 1.96 for 8-14 days, 95% CI 1.50-2.57), reflective of disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic oncology appointment (HR death 1.19 for 46-60 days, 95% CI 1.04-1.36, and HR death 1.42 for 61-75 days, 95% CI 1.11-1.83). CONCLUSIONS Regionalization of surgery for high-grade endometrial cancer has not had an impact on surgical wait times. Patients who have surgery more than 45 days after surgical consultation have reduced survival.
Collapse
Affiliation(s)
- Andra Nica
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | - Rachel Kupets
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | - Allan Covens
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | | | - Sarah E Ferguson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Lilian T Gien
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada.
| |
Collapse
|
4
|
Endometriumkarzinom: Zentralisierung von Operationen verbessert Überleben. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1383-6136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|