Fragmentation of practice: The adverse effect of surgeons moving around

Invited Commentary on “Fragmentation of Practice: The Adverse Effect of Surgeons Moving Around”

“…The authors find higher RFP surgeons had lower TO, higher perioperative complications, increased 90-day mortality, and 90-day readmissions rates. 3 Notably, these results remained significant even after controlling for surgeon procedure-specific volume, a factor that has previously been positively associated with improved outcomes. 2 Does this mean surgeons should be limited to working at just one center?…”

“…In this issue of Surgery, Hyer et al examine the impact of surgeons operating at multiple hospitals on patient outcomes. 3 Hyer et al present a well-designed analysis of Medicare beneficiaries undergoing elective surgical procedures and compare "rate of fragmented practice" (RFP; ie, operating at increasing number of hospitals) to "textbook outcome" (TO; a metric for postoperative outcome assessment) to assess whether surgical team familiarity is associated with improved postoperative outcomes. The authors find higher RFP surgeons had lower TO, higher perioperative complications, increased 90-day mortality, and 90-day readmissions rates.…”