Surgeon Volume Directly Related to Surgical Outcomes

Surgeon Volume Directly Related to Surgical Outcomes

According to a recent article published in The New England Journal of Medicine, operative mortality, or death related to a surgical procedure, is significantly reduced if surgeons have performed a large volume of the surgical procedure.

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Several prior publications have indicated that outcomes of patients undergoing surgery may be significantly improved if they are treated in a hospital that has performed a large volume of such procedures.

2-6 These results are presumed to be due to a more skilled and dedicated healthcare team that has experience with high-risk situations, as well as the attendance of skilled surgeons in such hospitals. However, the role of an individual surgeon in terms of surgical volume and patient outcome has been less well-defined in medical literature.

Researchers from the Dartmouth-Hitchcock Medical Center, the Institute for Clinical Evaluative Services and the Maine Medical Center recently evaluated operative mortality rates for complex surgeries, including surgeries for cancer, and possible associations between patient outcomes and the volume of the specific procedures performed by an individual surgeon. This study involved over 474,000 patients who underwent surgery for the removal (resection) of lung cancer, esophageal cancer, pancreatic cancer or bladder cancer, or 1 of 4 complex cardiac (heart) procedures. In this study, operative mortality was defined as death within 30 days of the procedure or before hospital discharge from the procedure. For all surgical procedures evaluated, the volume of the specific procedures performed by an individual surgeon significantly affected operative mortality. Operative deaths were increased by 24% following surgery for lung cancer, 83% for surgery of bladder cancer, 130% for surgery of esophageal cancer and 361% for surgery of pancreatic cancer in patients who had a surgeon who had performed a low-volume of the specific procedure, compared to those who had a surgeon who had performed a high volume of the procedure. Although hospital volume did have an effect on operative mortality following some procedures, this effect was largely due to surgical volume of an individual surgeon practicing in the hospital.

The researchers concluded that patients undergoing complex surgical procedures have a significantly reduced risk of operative mortality if their surgeon has performed a large volume of the specific procedure, compared to patients whose surgeon has performed a low volume of the procedure. An accompanying editorial in The New England Journal of Medicine states that the evidence that is now available is more than sufficient to support an insistence that informed consent for high-risk elective surgical procedures include information about the specific outcomes among patients of both the institution and the individual surgeon involved.

7 Patients who are to undergo a complex surgical procedure should speak with their surgeon about their particular risks or ask their physician to refer them to a surgeon who performs a large number of the surgical procedure in which they are to undergo for treatment of their disease.

References:

1.Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon Volume and Operative Mortality in the United States.

The New England Journal of Medicine. 2003;349:2117-2127.

  1. Birkmeyer J, Siewers AE, Finlayson EVA, et al. Hospital Volume and Surgical Mortality in the United States.

The New England Journal of Medicine. 2002;346:1128-37.

  1. Begg C, Elyn R. Riedel ER, et al. Variations in morbidity after radical prostatectomy.

The New England Journal of Medicine.2002;346:1138-1144.

  1. Hu J, Gold K, Pashos C, et al. Role of surgeon volume in radical prostatectomy outcomes.

Journal of Clinical Oncology. 2003:21: 401-405.

  1. Hodgson DC, Zhang W, Zaslavsky AM. Relation of Hospital Volume to Colostomy Rates and Survival for Patients with Rectal Cancer.

Journal of the National Cancer Institute. 2003;95:708-716.

  1. Smith TJ, Hillner BE and Bear HD. Taking Action on the Volume-Quality Relationship: How Long Can We Hide Our Heads in the Colostomy Bag.

Journal of the National Cancer Institute. 2003;95:695-697.

  1. Kizer KW, Editorial: The Volume Conundrum.

The New England Journal of Medicine. 2003;349:2159-2161.

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