Surgeon volume does not predict outcomes in the setting of technical credentialing

Results from a randomized trial in colon cancer

David W. Larson, Peter W. Marcello, Sergio W. Larach, Steven D. Wexner, Adrian Park, John Marks, Anthony J. Senagore, Alan G. Thorson, Tonia M. Young-Fadok, Erin Green, Daniel J. Sargent, Heidi Nelson

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: To test the hypothesis that surgeon volume would not predict short- and long-term outcomes when evaluated in the setting of technical credentialing. Summary Background Data: Surgical volume is a known predictor of outcomes; the importance of technical credentialing has not been evaluated. Methods: Fifty-three credentialed surgeons operated on 871 patients in the Clinical Outcomes of Surgical Therapy Study (NCT00002575), investigating laparoscopic versus open surgery for colon cancer. Credentialing required that each surgeon document performance of at least 20 laparoscopic colon cases and demonstrate oncologic techniques on a video-recorded case. Surgeons were separated based on volume entered into the trial (low, ≤5 cases (n = 39); medium, 6-10 cases (n = 9); or high, >10 cases (n = 5)) and compared by outcomes. Results: Patients treated by high volume compared with medium or low volume surgeons were older (70, 66, and 68 years; P <0.001), more often had right-sided tumors (63%, 46%, and 53%; P <0.001) and had more previous operations (48%, 38% and 45%; P <0.004), respectively. Mean operative times were shorter (123, 147 and 145 minutes; P <0.001), distal margins longer (13.4, 12.4 and 11.6 cm; P = 0.005), and lymph node harvest greater (14.8, 12.8, 12.6; P = 0.05) for high versus medium versus low volume surgeons. However, rates of conversion, complications, 5-year survival, and disease-free survival showed no significant differences. Conclusion: When tested in a randomized controlled trial with case-specific surgical technical credentialing and auditing, surgeon volume did not predict differences in rates of conversion, complications, or long-term cancer outcomes. Case-specific technical credentialing should be further studied specific to the role it could play in creating consistent, high quality outcomes.

Original languageEnglish (US)
Pages (from-to)746-750
Number of pages5
JournalAnnals of Surgery
Volume248
Issue number5
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Credentialing
Colonic Neoplasms
Operative Time
Surgeons
Disease-Free Survival
Neoplasms
Colon
Randomized Controlled Trials
Lymph Nodes
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Surgeon volume does not predict outcomes in the setting of technical credentialing : Results from a randomized trial in colon cancer. / Larson, David W.; Marcello, Peter W.; Larach, Sergio W.; Wexner, Steven D.; Park, Adrian; Marks, John; Senagore, Anthony J.; Thorson, Alan G.; Young-Fadok, Tonia M.; Green, Erin; Sargent, Daniel J.; Nelson, Heidi.

In: Annals of Surgery, Vol. 248, No. 5, 11.2008, p. 746-750.

Research output: Contribution to journalArticle

Larson, DW, Marcello, PW, Larach, SW, Wexner, SD, Park, A, Marks, J, Senagore, AJ, Thorson, AG, Young-Fadok, TM, Green, E, Sargent, DJ & Nelson, H 2008, 'Surgeon volume does not predict outcomes in the setting of technical credentialing: Results from a randomized trial in colon cancer', Annals of Surgery, vol. 248, no. 5, pp. 746-750. https://doi.org/10.1097/SLA.0b013e31818a157d
Larson, David W. ; Marcello, Peter W. ; Larach, Sergio W. ; Wexner, Steven D. ; Park, Adrian ; Marks, John ; Senagore, Anthony J. ; Thorson, Alan G. ; Young-Fadok, Tonia M. ; Green, Erin ; Sargent, Daniel J. ; Nelson, Heidi. / Surgeon volume does not predict outcomes in the setting of technical credentialing : Results from a randomized trial in colon cancer. In: Annals of Surgery. 2008 ; Vol. 248, No. 5. pp. 746-750.
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abstract = "Objective: To test the hypothesis that surgeon volume would not predict short- and long-term outcomes when evaluated in the setting of technical credentialing. Summary Background Data: Surgical volume is a known predictor of outcomes; the importance of technical credentialing has not been evaluated. Methods: Fifty-three credentialed surgeons operated on 871 patients in the Clinical Outcomes of Surgical Therapy Study (NCT00002575), investigating laparoscopic versus open surgery for colon cancer. Credentialing required that each surgeon document performance of at least 20 laparoscopic colon cases and demonstrate oncologic techniques on a video-recorded case. Surgeons were separated based on volume entered into the trial (low, ≤5 cases (n = 39); medium, 6-10 cases (n = 9); or high, >10 cases (n = 5)) and compared by outcomes. Results: Patients treated by high volume compared with medium or low volume surgeons were older (70, 66, and 68 years; P <0.001), more often had right-sided tumors (63{\%}, 46{\%}, and 53{\%}; P <0.001) and had more previous operations (48{\%}, 38{\%} and 45{\%}; P <0.004), respectively. Mean operative times were shorter (123, 147 and 145 minutes; P <0.001), distal margins longer (13.4, 12.4 and 11.6 cm; P = 0.005), and lymph node harvest greater (14.8, 12.8, 12.6; P = 0.05) for high versus medium versus low volume surgeons. However, rates of conversion, complications, 5-year survival, and disease-free survival showed no significant differences. Conclusion: When tested in a randomized controlled trial with case-specific surgical technical credentialing and auditing, surgeon volume did not predict differences in rates of conversion, complications, or long-term cancer outcomes. Case-specific technical credentialing should be further studied specific to the role it could play in creating consistent, high quality outcomes.",
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AU - Larach, Sergio W.

AU - Wexner, Steven D.

AU - Park, Adrian

AU - Marks, John

AU - Senagore, Anthony J.

AU - Thorson, Alan G.

AU - Young-Fadok, Tonia M.

AU - Green, Erin

AU - Sargent, Daniel J.

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