Does higher surgeon volume impact surgical outcomes?
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Impact of Higher Surgeon Volume on Surgical Outcomes
Introduction to Surgeon Volume and Surgical Outcomes
Surgeon volume, defined as the number of surgeries performed by a surgeon within a specific timeframe, has been identified as a critical factor influencing surgical outcomes across various medical fields. This article synthesizes findings from multiple systematic reviews and meta-analyses to explore the relationship between higher surgeon volume and surgical outcomes.
Orthopedic Surgery: Total Hip Arthroplasty
In orthopedic surgery, particularly in primary total hip arthroplasty (THA), higher surgeon volume is associated with improved postoperative outcomes. Studies indicate that patients operated on by high-volume surgeons experience shorter hospital stays, reduced costs, and lower dislocation rates. Additionally, there is a significant association between higher surgeon volume and better early-term and midterm survivorship, although this trend does not extend to long-term survivorship.
Spine Surgery
The impact of surgeon volume on spine surgery outcomes has also been extensively studied. Higher surgeon volume correlates with a lower risk of postoperative complications, shorter length of stay, reduced hospital costs, and decreased rates of readmissions and reoperations. These findings suggest that higher volume surgeons achieve better overall outcomes in spine surgeries, although further research is needed to establish specific volume thresholds for different spine procedures.
Radical Prostatectomy
In the context of radical prostatectomy for nonmetastatic prostate cancer, both surgeon and hospital volumes play a significant role in determining surgical outcomes. Higher volumes are linked to lower rates of positive surgical margins, reduced need for adjuvant or salvage therapies, and fewer perioperative complications. The benefits of higher volume become apparent at a threshold of approximately 86 cases per year, with outcomes continuing to improve beyond this point .
Gynecological Surgery
For gynecological surgeries, including hysterectomy and pelvic floor repair, higher surgeon volume is associated with lower rates of total, intraoperative, and postoperative complications. In gynecological oncology, high-volume surgeons also achieve lower mortality rates. These findings underscore the importance of surgical experience in minimizing adverse outcomes in gynecological procedures.
Esophageal and Gastric Cancer Surgery
In esophageal and gastric cancer surgeries, higher hospital and surgeon volumes are linked to better short-term outcomes, such as lower 30-day mortality and reduced anastomotic leakage rates. However, the impact on 90-day mortality is less consistent. The centralization of these surgeries to high-volume centers has been suggested to improve patient outcomes significantly .
Colorectal Cancer Surgery
Higher surgeon and hospital volumes are associated with reduced 30-day and intraoperative mortality rates in colorectal cancer surgery. High-volume surgeons also achieve better long-term outcomes, including greater 5-year survival rates, higher lymph node retrieval, and lower recurrence rates. The best outcomes are observed in high-volume hospitals with high-volume surgeons, highlighting the combined effect of institutional and individual experience.
Conclusion
The evidence consistently supports the notion that higher surgeon volume leads to better surgical outcomes across various specialties. This relationship underscores the importance of surgical experience and suggests potential benefits from centralizing complex surgeries to high-volume surgeons and institutions. Future research should aim to establish specific volume thresholds and explore the long-term implications of these findings on healthcare policies and patient care.
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