31 Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data

Abstract Aim Despite increasing evidence supporting cancer services centralisation, no consensus exists in the association between high-hospital or high-surgeon volume and mortality following colorectal surgery. This study aimed to identify characterise a volume-outcome relationship cancer. Method National Bowel Cancer Audit (NBOCA) dataset was combined with Association of Coloproctology Great Britain Ireland (ACPGBI) Clinical Outcomes Publication (COP) 2019 report. Adjusted 90-day 2-year were derived from patients included 2018 2016 datasets, respectively. The impact centre volume, surgeon ACPGBI membership rates on outcomes assessed. Cumulative sum (CUSUM) analysis performed threshold. Results 144 hospitals included, 17,235 17,703 781 surgeons identified, 478 holding memberships. No significant difference found volumes for adjusted mortality. High significantly associated reduced (p=0.006), but not (p=0.198). CUSUM 36 per year as threshold (p=0.003) 15 surgeries (p=0.241). Conclusions high degree existing centralisation UK limits number true low-volume centres compared other countries. Surgeon may be better predictor surgery than volume. More granular data is needed improve current understanding