Defining Volume Thresholds for Colorectal Cancer Surgery Using Stratum Specific Likelihood Ratios.
Optimal hospital volume threshold for colorectal cancer surgery is 71 resections per year.
Defining Volume Thresholds for Colorectal Cancer Surgery Using Stratum Specific Likelihood Ratios.
Higher procedure volume correlates with improved surgical outcomes, yet recent literature has questioned whether this relationship persists in modern times.
(1) To define hospital-level volume thresholds for colorectal cancer resections using stratum-specific likelihood ratios, (2) assess these thresholds across multiple outcome measures, procedure types, and tumor locations, and (3) examine whether the volume-outcome relationships persist across temporal cohorts.
National Cancer Database from 2004-2020.
Overall, 1,052,875 patients underwent colorectal resection at 1344 hospitals.
Consistent gradients were also observed across 30-day mortality and textbook outcome and persisted across procedure types and tumor locations.
Volume-outcome associations remained significant across all temporal cohorts, including the most recent period (2016-2020; p <0.001).
LIMITATIONS: Limited to Commission on Cancer facilities, lacks granular hospital characteristics, restricted to malignant indications.
Stratum-specific likelihood ratios reveal persistent volume-outcome associations for colorectal cancer resections across multiple strata, even in contemporary data.
These findings suggest that the reports of an attenuated volume-outcome relationship may reflect limitations of a single, static volume cutoff, rather than weakening of this association. See Video Abstract.