The Volume-Outcome Relationship & How It Impacts Your Safety

Why the number of comparable procedures your surgeon has performed is crucial to avoid complications.  

How should I pick a surgeon?

Within a specialized hospital, you should look for the surgeon who is most experienced with your procedure. If you’re choosing between two equally qualified surgeons for your wrist surgery, your risk of complication reduces if you go to a surgeon who only does wrist procedures rather than also providing elbow and hand surgery. The reason is simple: the more a surgeon performs a specific procedure, the more adept they become at it, leading to fewer complications and better patient outcomes.  

The impact of the volume relationship

This results from the volume-outcome relationship, which refers to the correlation between the number of procedures a surgeon performs and the outcomes of those procedures. A review published in the Annals of Surgery found that for each increase of 100 in the annual volume of surgeries performed, patient mortality decreased by 21%.  

Does this depend on the type of surgery performed?

This concept is reinforced by numerous studies. A notable study published in the British Journal of Surgery investigated the impact of surgical experience on the prognosis of esophageal cancer patients. The findings were substantial: surgeons who frequently performed the procedure, referred to as ‘high-volume’ surgeons, boasted a 5-year survival rate of 47%. In contrast, their ‘low-volume’ counterparts — those who conducted the surgery less frequently — had a significantly lower survival rate at just 25%. The implications become even more profound when we look at complex surgeries. In an insightful study by the New England Journal of Medicine on pancreatic resections, a stark contrast in outcomes was observed. Surgeons who frequently conducted this high-risk procedure had a mortality rate of merely 3.8%. Meanwhile, less experienced, ‘low-volume’ surgeons had a mortality rate that soared to 16.3%. A surgeon’s journey to proficiency is quantifiable, too. A 2017 study in The Journal of Bone & Joint Surgery scrutinized the learning curve for hip arthroscopy, a highly specialized procedure. The researchers found that a surgeon typically needed to perform approximately 59 procedures to surpass the learning curve. These findings collectively underscore the criticality of a surgeon’s specialization and volume of procedures. They are not just markers of professional expertise but crucial determinants of patient outcomes. Therefore, when selecting a surgeon, their experience and specialization in the specific procedure should be given considerable weight.  

Experienced surgeons can anticipate complications

Specialized surgeons are more equipped to anticipate potential issues, properly prepare the patient for surgery, and manage the postoperative care effectively. A study in the “American Journal of Medicine” found that surgeons who specialized in particular procedures were better able to manage preoperative and postoperative care, leading to lower complication rates and better patient outcomes. A study published in “BMJ” found that patients treated by high-volume surgeons had shorter hospital stays and were less likely to be readmitted within 30 days, indicating faster recovery and fewer postoperative complications. Further, surgeons who focus on a narrow area are more likely to keep up-to-date with the latest research, techniques, and technologies in their specialty. This means patients have access to the most current, evidence-based treatments. Read the full study here: https://link.springer.com/article/10.1007/s00423-020-01907-x