{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:06:09Z","timestamp":1783152369175,"version":"3.54.6"},"reference-count":46,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S020470\/1"],"award-info":[{"award-number":["MR\/S020470\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Evidence for a positive volume\u2013outcome relationship for rectal cancer surgery is unclear. This study aims to evaluate the volume\u2013outcome relationship for rectal cancer surgery at hospital and surgeon level in the English National Health Service (NHS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>All patients undergoing a rectal cancer resection in the English NHS between 2015 and 2019 were included. Multilevel multivariable logistic regression was used to model relationships between outcomes and mean annual hospital and surgeon volumes (using a linear plus a quadratic term for volume) with adjustment for patient characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 13\u2009858 patients treated in 166 hospitals were included. Six hospitals (3.6%) performed fewer than 10 rectal cancer resections per year, and 381 surgeons (45.0%) performed fewer than five such resections per year. Patients treated by high\u2010volume surgeons had a reduced length of stay (<jats:italic>p<\/jats:italic>\u2009=\u20090.016). No statistically significant volume\u2013outcome relationships were demonstrated for 90\u2010day mortality, 30\u2010day unplanned readmission, unplanned return to theatre, stoma at 18\u2009months following anterior resection, positive circumferential resection margin and 2\u2010year all\u2010cause mortality at either hospital or surgeon level (<jats:italic>p<\/jats:italic> values\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Almost half of colorectal surgeons in England do not meet national guidelines for rectal cancer surgeons to perform a minimum of five major resections annually. However, our results suggest that centralizing rectal cancer surgery with the main focus of increasing operative volume may have limited impact on NHS surgical outcomes. Therefore, quality improvement initiatives should address a wider range of evidence\u2010based process measures, across the multidisciplinary care pathway, to enhance outcomes for patients with rectal cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16745","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:43:47Z","timestamp":1694666627000},"page":"1981-1993","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["What is the impact of hospital and surgeon volumes on outcomes in rectal cancer surgery?"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-957X","authenticated-orcid":false,"given":"Jemma M.","family":"Boyle","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"van der Meulen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Kuryba","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Cowling","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Oncology The Christie NHS Foundation Trust  Manchester UK"},{"name":"School of Medical Sciences University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Department of Oncology Guy's and St. Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola S.","family":"Fearnhead","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Cambridge University Hospitals  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.20.1747"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.7.721"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa035205"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197912203012503"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.4952"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002965"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2018.01.001"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.05.023"},{"issue":"3","key":"e_1_2_13_10_1","article-title":"Workload and surgeon's specialty for outcome after colorectal cancer surgery","author":"Archampong D","year":"2012","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001198"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00159-X"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9264"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k1581"},{"key":"e_1_2_13_15_1","unstructured":"National Institute for Health and Care Excellence.Colorectal cancer. 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