High Case Volume Does Not Translate Into Improved Patient Outcomes in Laparoscopic Partial Colectomy.

Shaun Daly, MD, Daniel Rinewalt, MD, Theodore Saclarides, MD, Dana Hayden, MD, Jonathan Myers, MD, Daniel Deziel, MD, Minh Luu, MD

Rush University Medical Center, Loyola Medical Center

Introduction: The aim of our study was to evaluate if a surgeon’s case volume impacts patient outcomes after laparoscopic partial colectomy. The importance of the study is to provide objective evidence regarding the current use of surgical case volume in granting or renewing hospital privileges, especially for minimally invasive procedures.

Methods and Procedures: We performed a retrospective cohort study of 256 patients who underwent a laparoscopic partial colectomy performed by either high-volume (HV) surgeons (n=207 patients) or low-volume (LV) surgeons (n=49 patients) at a single institution between 2008-2012. A HV surgeon was defined as performing >10 laparoscopic partial colectomies per year in addition to a minimum of 25 total cases performed. Background training of LV surgeons included one with extensive hepatobiliary training, two with advanced minimally invasive training and one with additional colorectal training after widespread laparoscopic integration.. Training of our HV surgeons included two with advanced colorectal training prior to widespread laparoscopic integration. Patient demographics, perioperative variables and patient outcomes were evaluated for significance using multivariate logistic regression.

Results: Patient demographics did not differ significantly between cohorts. The average operative time for HV surgeons was 202 mins compared to 190 mins for LV surgeons (p=0.79). Median estimated blood loss was greater for HV than LV surgeons (150 mL vs. 100 mL, p=0.03), however this did not translate into significantly more blood transfusions (8 vs 0, p=0.18). Median length of stay (LOS) for HV surgeons was 4 days with mean ICU stay of 3 days compared to a median LOS of 5 days (p=0.45) and mean ICU stay of 1 day for LV surgeons. Early complications for HV surgeons totaled 50 (24.2%) compared to 7 (14.3%) for LV surgeons (p=0.19). Late complications for HV surgeons totaled 8 (3.9%) compared to 2 (4.1%) for LV surgeons (p=0.60). Median number of harvested lymph nodes by HV and LV surgeons was similar (18 vs. 19, p=0.23).

Conclusion: The surgical case volume of the surgeon performing a laparoscopic partial colectomy does not impact patient outcomes. Advanced fellowship training in colorectal or minimally invasive surgery produced similar patient outcomes despite individual surgeon case volume. The use of surgical case volume for granting technique-specific minimally invasive surgical privileges should not be emphasized.

Session: Poster Presentation

Program Number: P106

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