Abstract
Abstract Background Although centralisation has shown benefit for uncommon cancers and high-risk surgeries, there is controversy regarding its benefit for common malignancies. Minor improvements in colorectal surgical morbidity and mortality have the potential to save lives and conserve limited hospital resources. Aim To investigate the relationship between number of major resection cases per hospital and patient outcome measures. The proposed hypothesis was that number of major cases per hospital is inversely proportional to 90-day mortality, 30-day unplanned readmission, and 2-year mortality rates. Method A correlative study using National Bowel Cancer Audit data from 2016-18 in England was performed. The target population was colorectal cancer patients requiring major resection surgery in England. Bivariate analysis was used to investigate the relationship between number of major resections per hospital, and: 90-day mortality, 30-day unplanned readmission, and 2-year mortality rates. Results Combined patient outcome measures from 56,347 cases across 145 hospitals over 2016-18 were assessed. Correlation coefficients demonstrated no significant correlation between the three studied outcome measures (90-Day mortality [r = 0.100, -0.067-0.257, p = 0.240]; 30-day unplanned readmission rate [r = 0.093,-0.073-0.270, p = 0.284]; 2-year mortality [r = -0.069, -0.236-0.097, p = 0.411]). There is insufficient evidence to conclude a statistically significant relationship between number of major resections per hospital and the patient outcomes studied. Conclusions Centralising care by increasing hospital volume is unlikely a solution to improving colorectal patient outcomes in England. This may reflect the UK’s dedicated colorectal surgical training and minimum resection numbers for accreditation. Further studies will need to assess variables such as surgeon volume and case-mix, particularly with regard to rectal surgery.
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