Management and Outcomes in a Low-volume Cerebral Aneurysm Practice

Naso, William B.; Rhea, Andrew H.; Poole, Allen

doi:10.1097/00006123-200101000-00016

Cited by 13 publications

(11 citation statements)

References 29 publications

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“…This challenged current health policy initiatives proposing strict hospital volume thresholds for carotid endarterectomy. Naso and colleagues 19 documented their excellent results with cerebral aneurysm clip occlusion in a low-volume practice. These authors did stress, however, the importance of a multidisciplinary subspecialty approach in the management of these patients.…”

Section: Discussionmentioning

confidence: 98%

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral

Cowan

Dimick²,

Wainess

et al. 2003

Journal of Neurosurgery

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Section: Discussionmentioning

confidence: 98%

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral

Cowan

Dimick²,

Wainess

et al. 2003

Journal of Neurosurgery

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“…Saunders et al30 agree that the threshold at which a low‐volume surgeon becomes “experienced”—at least in respect of thyroid surgery—is unclear. In neurosurgery where surgical volume may be relatively low compared with some high‐volume centers but still sufficient to produce equivalent outcomes,14, 31 there is also apparently no “experience threshold” for optimal outcomes 32…”

Section: Discussionmentioning

confidence: 99%

Efficacy of neck dissection: Are surgical volumes important?

et al. 2009

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We have demonstrated that there is a "learning curve" for neck dissection. Our most experienced surgeon harvested on average 11 more nodes than similar specimens submitted by the group of inexperienced surgeons. The effect of experience remains significant even without adjusting for time (P < .001). Surgical experience also affects clinical outcome months after the dissection. This retrospective review supports surgical volume as an indicator of expertise in neck dissection that could be used to assess trainees' progress and for quality assurance in large head and neck units. Laryngoscope, 2009.

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“…Specifically, the discharges with an SV range of 19 to 51 in the NIS and .26 in the SID were associated with a decreased odds of complication as their SVs increased, consistent with the findings of other studies assessing SV. [1][2][3][4][5][6][7][8][9][10][11][12][13] This suggests that these higher-volume surgeons may be performing safer surgery. Increasing SV was not associated with a change in complication rate for SV \5 and SV .51 in the NIS and for SV \27 in the SID.…”

Section: Discussionmentioning

confidence: 99%

Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis

Campbell

Lee

Cannon

et al. 2021

Otolaryngol.--head neck surg.

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Objective To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. Study Design Retrospective review. Setting Two US databases spanning 2000 to 2014. Methods Neck dissections for squamous cell carcinoma from the National Inpatient Sample and State Inpatient Databases were analyzed. The primary outcome was any in-hospital complication common to neck dissection. The principal independent variable was surgeon volume. A multivariable logistic generalized estimating equation with a piecewise linear spline for surgeon volume was fit to assess its association with complication. Results The National Inpatient Sample had 3517 discharges fitting criteria, a median surgeon volume of 12, and an 11.1% complication rate. A 1-unit increase in surgeon volume was associated with a 7% increase in the odds of complication when volume ranged between 4 and 19 (adjusted odds ratio [AOR], 1.07; 95% CI, 1.04-1.11) and with a 3% decrease in the odds of complication when volume ranged between 19 and 51 (AOR, 0.97; 95% CI, 0.96-0.99). The State Inpatient Databases had 2876 discharges fitting criteria, a median surgeon volume of 30, and a 13.5% complication rate. Surgeon volume was not associated with complication when <27 (AOR, 1.01; 95% CI, 0.99-1.02), but a 5-unit increase in volume was associated with a 7% decrease in the odds of complication with volume ≥27 (AOR, 0.93; 95% CI, 0.88-0.98). Conclusions Surgeon volume was associated with complications for most volume ranges and with lower odds of complication for high-volume surgeons.

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Management and Outcomes in a Low-volume Cerebral Aneurysm Practice

Cited by 13 publications

References 29 publications

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral

Efficacy of neck dissection: Are surgical volumes important?

Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis

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