Gani F, et al. – Authors aimed at assessing the comparative benefit of laparoscopic colorectal surgery relative to surgeon volume. Although laparoscopic surgery was associated with improved postoperative clinical outcomes, there appeared some effect of surgeon volume on laparoscopic surgery outcome.

Methods

• Authors used the MarketScan Database from 2010–2014 to identify commercially insured patients aged 18 to 64 years undergoing a colorectal resection.
• To calculate and compare postoperative mortality/morbidity by operative approach relative to surgeon volume, they used multivariable logistic regression analysis.

Results

• Inclusion criteria was met by a total of 21,827 patients.
• The median age was 53 years (interquartile range: 46–59); a slight majority of female patients (n = 11,248, 51.5%) was observed.
• 49.2% of patients underwent laparoscopic operations(n = 10,756), whereas an open colorectal resection was performed on 50.7% (n = 11,071).
• Multivariable analysis suggested that laparoscopic surgery was associated with 64% decreased odds of developing a postoperative complication or mortality (odds ratio = 0.36, 95% confidence interval, 0.32–0.41, P < .001).
• Colectomy performed by a higher operative volume surgeon (high versus low: odds ratio = 0.68, 95% confidence interval, 0.61–0.77, P < .001) seemed associated with decreased odds of developing a postoperative complication/mortality.
• Interestingly the potential decrease in risk–adjusted morbidity/mortality between laparoscopic and open surgery was somewhat greater among high–operative–volume surgeons (odds ratio = 0.29, 95% confidence interval, 0.25–0.34, P < .001) and intermediate–operative–volume surgeons (odds ratio = 0.30, 95% confidence interval, 0.25–0.36, P < .001) compared with low–operative–volume surgeons (odds ratio = 0.36, 95% confidence interval, 0.32–0.41, P < .001).