The Influence of Volume and Experience on Individual Surgical Performance

Maruthappu, Mahiben; Gilbert, Barnabas J; El‐Harasis, Majd A.; Nagendran, Myura; McCulloch, Peter; Duclos, Antoine; Carty, Matthew J.

doi:10.1097/sla.0000000000000852

Cited by 175 publications

(120 citation statements)

References 39 publications

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“…3,4 It may be that senior surgeons pre fer to operate earlier in the week and tend to have better outcomes over a wide range of surgical procedures than less experienced sur geons. 5 Friday surgeries also result in a greater proportion of post operative care occurring on the weekend, a time when there are fewer health care personnel in the hospital and less access to diag nostic services. [6][7][8][9][10][11][12] We investigated whether elective surgery performed later in the week was associated with a higher mortality than elective sur gery performed earlier in the week in a Canadian population and whether the association was influenced by surgeon experience and volume.…”

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confidence: 99%

Association between day of the week of elective surgery and postoperative mortality

Dubois

Vogt

Vinden

et al. 2016

CMAJ

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confidence: 99%

Association between day of the week of elective surgery and postoperative mortality

Dubois

Vogt

Vinden

et al. 2016

CMAJ

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“…Maintaining a high individual surgical volume is important to optimize operative results. Prior studies have found that surgeon volume is associated with improved outcomes in a number of surgical procedures [12] as varied as hip replacements [11] and colon cancer resections [14]. Birkmeyer et al [3] further asserted that surgeon volume is the driving factor behind the association of hospital volume and operative mortality.…”

Section: Discussionmentioning

confidence: 99%

How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?

Miller

Rajani

Leddy

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions. Questions/purposes The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice. Methods Fifteen fellowship-trained orthopaedic oncologists out of a potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting complete operative case lists for a 2-year period. We recorded the type of procedure and determined associations between the annual number of tumor operations and total operative caseload, years in practice, and some details of individual (range, 63-356) and median annual number of tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated with the total annual number of operations (r = 0.73, p \ 0

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“…However, several potential hypotheses have been proposed, including a propensity towards increased mental fatigue, reduced compliance with evidencebased medicine and reduced stress tolerance among older surgeons. 25 It has also been suggested that the increasing administrative, research and leadership responsibility associated with seniority may also contribute.…”

Section: Discussionmentioning

confidence: 99%

The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis

et al. 2016

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Objectives: The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. Design: Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. Setting: Tertiary care academic hospital. Participants: All patients undergoing TKR at the host institution in 1996-2009. Main outcome measure: Operative efficiency. Results: A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. Conclusions: Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedurespecific quality improvement strategies in surgery.

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The Influence of Volume and Experience on Individual Surgical Performance

Abstract: Increasing surgical case volume and years of practice are associated with improved performance, in a procedure-specific manner. Performance may deteriorate toward the end of a surgeon's career.

Cited by 175 publications

References 39 publications

Association between day of the week of elective surgery and postoperative mortality

Association between day of the week of elective surgery and postoperative mortality

How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?

The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis

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