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The Impact of Surgeon Volume on Postoperative Outcomes After Surgery for Crohn's Disease

Nguyen, Geoffrey C. MD, PhD*,†,‡; Steinhart, A. Hillary MD, MSc*,‡

doi: 10.1097/01.MIB.0000438247.06595.b9
Original Clinical Articles

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.

Article first published online 26 December 2013

*Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; and

Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.

Reprints: Geoffrey C. Nguyen, MD, PhD, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, 600 University Avenue, Suite 437, Toronto, Ontario M5G 1X5, Canada (e-mail:

Supported partly by the Division of Gastroenterology at Mount Sinai Hospital and an operating grant from the Canadian Institutes of Health Research (CIHR).

G. C. Nguyen is a recipient of New Investigator Awards from the Canadian Institutes of Health Research (CIHR), the Canadian Association of Gastroenterology, and the Crohn's and Colitis Foundation of Canada; and has served on advisory boards for Janssen and Abbott. A. H. Steinhart has served on advisory boards for Janssen, Abbott, and Shire and has participated in the Speakers Bureau for Merck, Abbott, Shire, Aptalis, and Warner Chilcott. He has also received research support from Merck and Abbott.

The above pharmaceutical entities were not involved with this study in any capacity.

Received September 21, 2013

Accepted November 01, 2013

© Crohn's & Colitis Foundation of America, Inc.
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