The impact of surgeon volume on postoperative outcomes after surgery for Crohn's disease.

BACKGROUND

High hospital procedural volume has been associated with better postoperative inflammatory bowel disease outcomes. We assessed the independent contribution of surgeon volume to health outcomes after surgery for Crohn's disease.

METHODS

We identified 2842 individuals with Crohn's disease who underwent first inflammatory bowel disease-related surgery between 1996 and 2009. We assessed the association between surgeon volume, hospital volume, comorbidity and demographic variables, and postoperative outcomes.

RESULTS

The in-hospital mortality rate was 4.4%. Being in the lowest income, quintile was associated with 3-fold higher mortality compared with the highest income quartile (odds ratio, 3.10; 95% CI, 1.44-6.48). The late hospitalization (>3 mo after surgery) rate among those operated by surgeons in the bottom quartile for inflammatory bowel disease surgery volume was nearly 1.5-fold higher than that of those operated by surgeons in the second, third, and top quartiles (3.4/100 person-years [py] versus 2.4/100 py, 2.1/100 py, and 2.3/100 py, respectively; P < 0.05). After multivariate adjustment, the relative incidence ratio for late hospitalization for surgeons in the second, third, and top quartiles were 0.88 (95% CI, 0.83-0.93), 0.88 (95% CI, 0.83-0.94), and 0.87 (95% CI, 0.79-0.94) compared with the bottom quartile, respectively. The 5-year risk of recurrent surgery was 24.3%, and was not associated with surgeon volume.

CONCLUSIONS

Low surgeon volumes were associated with increased risk of late hospitalizations after Crohn's disease surgery. Prospective studies are warranted to elucidate whether this correlation is a late-onset consequence of surgical inexperience or other healthcare utilization factors that are associated with lower surgeon volume.