Surgeon Volume

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Martin D Batstone - One of the best experts on this subject based on the ideXlab platform.

  • treatment for oral squamous cell carcinoma impact of Surgeon Volume on survival
    Oral Oncology, 2019
    Co-Authors: Timothy Liu, Michael David, Owen G Ellis, Tsuhui Hubert Low, Carsten E Palme, Jonathan R Clark, Martin D Batstone
    Abstract:

    Abstract Background The Volume-outcome relationship is a well-known phenomenon in surgical oncology. The aim of this study was to quantify the impact of Surgeon Volume on the treatment outcome of oral squamous cell carcinoma (OSCC) patients. Methods All new OSCC cases treated with curative intent between 2008 and 2013 were included. A heterogeneous set of predictor variables was collected, including patient, tumour and treatment factors. The outcomes of interest were recurrence-free survival (RFS), overall survival (OS) and disease-specific survival (DSS). To investigate the cut-off in Surgeon Volume, the number of OSCC resections was analysed in multiplies of 5 cases per annum according to DSS, using univariable regression analysis. Results 534 cases were recruited. Independently, the negative predictors for patient survival were age, perineural invasion, worsening tumour staging, and extracapsular spread. High-Volume Surgeon was determined to be most significant at 20 cases per annum and significantly associated with improved RFS (HR: 0.67), OS (HR: 0.44), and DSS (HR: 0.39). Conclusions Results from this study support the rationalisation of OSCC management at high-Volume centres and in the hands of experienced Surgeons for better patient survival. Head and neck Surgeons should perform a minimum of 20 OSCC cases per year to maintain competency in OSCC ablation.

Azeem Tariq Malik - One of the best experts on this subject based on the ideXlab platform.

  • Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review.
    The Journal of arthroplasty, 2018
    Co-Authors: Azeem Tariq Malik, Nikhil Jain, Thomas J. Scharschmidt, Andrew H. Glassman, Safdar N. Khan
    Abstract:

    Abstract Background Surgeon Volume has been identified as an important factor impacting postoperative outcome in patients undergoing orthopedic surgeries. With an absence of a detailed systematic review, we sought to collate evidence on the impact of Surgeon Volume on postoperative outcomes in patients undergoing primary total hip arthroplasty. Methods PubMed (MEDLINE) and Google Scholar databases were queried for articles using the following search criteria: (“Surgeon Volume” OR “Provider Volume” OR “Volume Outcome”) AND (“THA” OR “Total hip replacement” OR “THR” OR “Total hip arthroplasty”). Studies investigating total hip arthroplasty being performed for malignancy or hip fractures were excluded from the review. Twenty-eight studies were included in the final review. All studies underwent a quality appraisal using the GRADE tool. The systematic review was performed in accordance with the PRISMA guidelines. Results Increasing Surgeon Volume was associated with a shorter length of stay, lower costs, and lower dislocation rates. Studies showed a significant association between an increasing Surgeon Volume and higher odds of early-term and midterm survivorship, but not long-term survivorships. Although complications were reported and recorded differently in studies, there was a general trend toward a lower postoperative morbidity with regard to complications following surgeries by a high-Volume Surgeon. Conclusion This systematic review shows evidence of a trend toward better postoperative outcomes with high-Volume Surgeons. Future prospective studies are needed to better determine long-term postoperative outcomes such as survivorship before healthcare policies such as regionalization and/or equal-access healthcare systems can be considered.

  • The impact of Surgeon Volume on patient outcome in spine surgery: a systematic review
    European Spine Journal, 2018
    Co-Authors: Azeem Tariq Malik, Usman Younis Panni, Muhammad Usman Mirza, Maryam Tetlay, Shahryar Noordin
    Abstract:

    Purpose Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher Volume centers and adoption of Volume standards. With limited literature promoting the regionalization of spine surgeries, we undertook a systematic review to investigate the impact of Surgeon Volume on outcomes in patients undergoing spine surgery. Methods We performed a systematic review examining the association between Surgeon Volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior cervical discectomy and fusion (ACDF), anterior/posterior cervical fusion, laminectomy/decompression, anterior/posterior lumbar decompression with fusion, discectomy, and spinal deformity surgery (spine arthrodesis). Results Studies were variable in defining Surgeon Volume thresholds. Higher Surgeon Volume was associated with a significantly lower risk of postoperative complications, a lower length of stay (LOS), lower cost of hospital stay and a lower risk of readmissions and reoperations/revisions. Conclusions Findings suggest a trend towards better outcomes for higher Volume Surgeons; however, further study needs to be carried out to define objective Volume thresholds for individual spine surgeries for Surgeons to use as a marker of proficiency.

  • The impact of Surgeon Volume on patient outcome in spine surgery: a systematic review
    European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2018
    Co-Authors: Azeem Tariq Malik, Usman Younis Panni, Maryam Tetlay, Muhammad Mirza, Shahryar Noordin
    Abstract:

    Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher Volume centers and adoption of Volume standards. With limited literature promoting the regionalization of spine surgeries, we undertook a systematic review to investigate the impact of Surgeon Volume on outcomes in patients undergoing spine surgery. We performed a systematic review examining the association between Surgeon Volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior cervical discectomy and fusion (ACDF), anterior/posterior cervical fusion, laminectomy/decompression, anterior/posterior lumbar decompression with fusion, discectomy, and spinal deformity surgery (spine arthrodesis). Studies were variable in defining Surgeon Volume thresholds. Higher Surgeon Volume was associated with a significantly lower risk of postoperative complications, a lower length of stay (LOS), lower cost of hospital stay and a lower risk of readmissions and reoperations/revisions. Findings suggest a trend towards better outcomes for higher Volume Surgeons; however, further study needs to be carried out to define objective Volume thresholds for individual spine surgeries for Surgeons to use as a marker of proficiency.

  • The impact of Surgeon Volume and hospital Volume on postoperative mortality and morbidity after hip fractures: A systematic review.
    International journal of surgery (London England), 2017
    Co-Authors: Azeem Tariq Malik, Usman Younis Panni, Bassam A. Masri, Shahryar Noordin
    Abstract:

    Abstract Introduction Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher Volume centers, and adoption of Volume standards. With limited literature investigating the impact of hospital and Surgeon Volume on the outcome of hip fracture repairs, we undertook a systematic review to solidify the findings and attempt to arrive at a definitive conclusion with respect to both factors. Materials and methods We performed a systematic review examining the association between Surgeon and hospital Volume and hip fracture outcomes. To be included in the review, the study population had to include patients undergoing any hip fracture repair such as hemiarthroplasty (HA), internal fixation (ORIF) and total hip arthroplasty (THA). A total of five studies investigating Surgeon Volume and twelve studies investigating hospital Volume were included in the study. With the exception of one study investigating both Surgeon and hospital Volume, Volume thresholds were defined for all studies. Results Studies were variable in defining Surgeon and hospital Volume thresholds. Low Surgeon Volume was associated with a longer LOS and a higher risk of mortality, but results were contrasting with respect to postoperative complications. High Volume hospitals fared better than low Volume with respect to length of stay, postoperative complications and time to surgery. Conclusions Increasing hospital Volume was a more stronger predictor of postoperative outcomes as compared to Surgeon Volume. However, there are still few researches with respect to Surgeon Volume and further studies may yield a more definitive answer to this question.

  • Does Surgeon Volume affect the outcome of total knee arthroplasties in a developing country? - A retrospective cohort study.
    Annals of medicine and surgery (2012), 2017
    Co-Authors: Azeem Tariq Malik, Syed Hamza Mufarrih, Arif Ali, Shahryar Noordin
    Abstract:

    Abstract Introduction Recent studies have shown that in addition to patient factors, Surgeon Volume has influenced total knee arthroplasty (TKA) outcomes greatly. With recent propositions of regionalization of arthroplasties to higher Volume centers, the need for further evidence is warranted. Materials and methods Retrospective Cohort Study done at Aga Khan University Hospital, Pakistan from January 2007 to December 2015. High Volume (HV) group was set as at least 50 TKAs/year and Low Volume (LV) was set as at most 25 TKAs/year. A total of 615 patients undergoing a unilateral or bilateral TKA were included in our study. Results LV group was associated with a higher length of stay (LOS) as compared to HV group in patients undergoing a bilateral TKA after adjusted logistic regression [OR 2.395 (1.47,3.91)]. We found no association between Surgeon Volume and postoperative complications. Conclusion Patients getting a bilateral TKA by LV Surgeons were twice more likely to have a longer LOS as compared to HV group. Further research is warranted comparing all aspects and possible confounders to different variables before a conclusion can be made.

Timothy Liu - One of the best experts on this subject based on the ideXlab platform.

  • treatment for oral squamous cell carcinoma impact of Surgeon Volume on survival
    Oral Oncology, 2019
    Co-Authors: Timothy Liu, Michael David, Owen G Ellis, Tsuhui Hubert Low, Carsten E Palme, Jonathan R Clark, Martin D Batstone
    Abstract:

    Abstract Background The Volume-outcome relationship is a well-known phenomenon in surgical oncology. The aim of this study was to quantify the impact of Surgeon Volume on the treatment outcome of oral squamous cell carcinoma (OSCC) patients. Methods All new OSCC cases treated with curative intent between 2008 and 2013 were included. A heterogeneous set of predictor variables was collected, including patient, tumour and treatment factors. The outcomes of interest were recurrence-free survival (RFS), overall survival (OS) and disease-specific survival (DSS). To investigate the cut-off in Surgeon Volume, the number of OSCC resections was analysed in multiplies of 5 cases per annum according to DSS, using univariable regression analysis. Results 534 cases were recruited. Independently, the negative predictors for patient survival were age, perineural invasion, worsening tumour staging, and extracapsular spread. High-Volume Surgeon was determined to be most significant at 20 cases per annum and significantly associated with improved RFS (HR: 0.67), OS (HR: 0.44), and DSS (HR: 0.39). Conclusions Results from this study support the rationalisation of OSCC management at high-Volume centres and in the hands of experienced Surgeons for better patient survival. Head and neck Surgeons should perform a minimum of 20 OSCC cases per year to maintain competency in OSCC ablation.

Julie A. Sosa - One of the best experts on this subject based on the ideXlab platform.

  • Each procedure matters: threshold for Surgeon Volume to minimize complications and decrease cost associated with adrenalectomy.
    Surgery, 2017
    Co-Authors: Kevin L. Anderson, Sanziana A. Roman, Michael T. Stang, Samantha M. Thomas, Mohamed A. Adam, Lauren N. Pontius, Randall P. Scheri, Julie A. Sosa
    Abstract:

    Background An association has been suggested between increasing Surgeon Volume and improved patient outcomes, but a threshold has not been defined for what constitutes a “high-Volume” adrenal Surgeon. Methods Adult patients who underwent adrenalectomy by an identifiable Surgeon between 1998–2009 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. Logistic regression modeling with restricted cubic splines was utilized to estimate the association between annual Surgeon Volume and complication rates in order to identify a Volume threshold. Results A total of 3,496 Surgeons performed adrenalectomies on 6,712 patients; median annual Surgeon Volume was 1 case. After adjustment, the likelihood of experiencing a complication decreased with increasing annual Surgeon Volume up to 5.6 cases (95% confidence interval, 3.27–5.96). After adjustment, patients undergoing resection by low-Volume Surgeons ( Conclusion This study suggests that an annual threshold of Surgeon Volume (≥6 cases/year) that is associated with improved patient outcomes and decreased hospital cost. This Volume threshold has implications for quality improvement, surgical referral and reimbursement, and surgical training.

  • Surgeon Volume trumps specialty: outcomes from 3596 pediatric cholecystectomies
    Journal of Pediatric Surgery, 2012
    Co-Authors: Kesi Chen, Kevin Cheung, Julie A. Sosa
    Abstract:

    Abstract Background Laparoscopic cholecystectomy is the standard surgical management of biliary disease in children, but there has been a paucity of studies addressing outcomes after pediatric cholecystectomies, particularly on a national level. We conducted the first study to address the effect of Surgeon specialty and Volume on clinical and economic outcomes after pediatric cholecystectomies on a population level. Methods We conducted a retrospective cross-sectional study using the Health Care Utilization Project Nationwide Inpatient Sample. Children (≤17 years) who underwent laparoscopic cholecystectomy from 2003 to 2007 were selected. Pediatric Surgeons performed 90% or higher of their total cases in children. High-Volume Surgeons were in the top tertile (n ≥ 37 per year) of total cholecystectomies performed. χ 2 , Analyses of variance, and multivariate linear and logistic regression analyses were used to assess in-hospital complications, median length of hospital stay (LOS), and total hospital costs (2007 dollars). Results A total of 3596 pediatric cholecystectomies were included. Low-Volume Surgeons had more complications, longer LOS, and higher costs than high-Volume Surgeons. After adjustment in multivariate regression, Surgeon Volume, but not specialty, was an independent predictor of LOS and cost. Conclusions High-Volume Surgeons have better outcomes after pediatric cholecystectomy than low-Volume Surgeons. To optimize outcomes in children after cholecystectomy, Surgeon Volume and laparoscopic experience should be considered above Surgeon specialty.

  • Outcomes From 3144 Adrenalectomies in the United States Which Matters More, Surgeon Volume or Specialty?
    Archives of surgery (Chicago Ill. : 1960), 2009
    Co-Authors: Henry S. Park, Sanziana A. Roman, Julie A. Sosa
    Abstract:

    OBJECTIVE To assess the effect of Surgeon Volume and specialty on clinical and economic outcomes after adrenalectomy. DESIGN Population-based retrospective cohort analysis. SETTING Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PARTICIPANTS Adults (>or=18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, Surgeon specialty (general vs urologist), Surgeon adrenalectomy Volume, and hospital factors were assessed. MAIN OUTCOME MEASURES The chi(2) test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs. RESULTS A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general Surgeons were high-Volume Surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-Volume Surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-Volume Surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13,168 vs $11,732, P = .02) than did general Surgeons. After adjustment for patient and provider characteristics in multivariate analyses, Surgeon Volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital Volume was associated only with LOS (0.8-day difference, P < .007). Surgeon Volume, specialty, and hospital Volume were not predictors of costs. CONCLUSION To optimize outcomes, patients with adrenal disease should be referred to Surgeons based on adrenal Volume and laparoscopic expertise irrespective of specialty practice.

  • Evolution of the Surgeon Volume / Patient Outcome Relationship
    Annals of Surgery, 2009
    Co-Authors: Leon Boudourakis, Tracy S. Wang, Sanziana A. Roman, Rani A. Desai, Julie A. Sosa
    Abstract:

    Objective:Higher Surgeon Volume is associated with improved patient outcomes. This finding has prompted recommendations for increasing specialization and referrals to high-Volume Surgeons, yet their implementation in clinical practice has not been measured.Methods:We performed cross-sectional analys

  • evolution of the Surgeon Volume patient outcome relationship
    Annals of Surgery, 2009
    Co-Authors: Leon Boudourakis, Tracy S. Wang, Sanziana A. Roman, Rani A. Desai, Julie A. Sosa
    Abstract:

    Objective:Higher Surgeon Volume is associated with improved patient outcomes. This finding has prompted recommendations for increasing specialization and referrals to high-Volume Surgeons, yet their implementation in clinical practice has not been measured.Methods:We performed cross-sectional analys

Ruud W Selles - One of the best experts on this subject based on the ideXlab platform.

  • Reply: Surgeon Volume and the Outcomes of Dupuytren's Surgery: Results from a Dutch Multicenter Study.
    Plastic and Reconstructive Surgery, 2018
    Co-Authors: Chao Zhou, Iris E Ceyisakar, Steven E R Hovius, Reinier Feitz, Harm P Slijper, Hester F Lingsma, Ruud W Selles
    Abstract:

    BACKGROUND: For many major surgical procedures, the outcomes are better when performed by Surgeons with higher procedure Volumes. The purpose of this study was to examine the relations between Surgeon procedure Volume and the outcomes of Dupuytren's surgery. METHODS: The authors conducted an observational study from 2011 to 2014 at six dedicated hand surgery practice sites in The Netherlands. Five hundred eighty-eight patients underwent surgery for Dupuytren's contracture performed by one of the 16 Surgeons. The main exposure variable was annual Surgeon Volume. Outcome measures were the degree of residual contracture, full release rate, and any postoperative adverse event examined within 3 months of surgery. RESULTS: Mean annual Surgeon Volume was 51 among the 16 Surgeons(range; 4-86) procedures. The majority of patients had primary disease (79 percent) and underwent open fasciectomy (74 percent). Multivariable regression analyses showed that Surgeon Volume was linearly related to all three outcomes, and identified no optimal Volume threshold. Performing 10 additional procedures annually was independently associated with nearly 0.8 degree less residual contracture (p = 0.002), 9 percent higher odds of attaining a full release (p = 0.037), and 11 percent lower odds of an adverse event (p < 0.001). Nonetheless, patient-related factors had larger impacts on all three clinical outcomes than Surgeon Volume. CONCLUSIONS: In this study of practicing hand Surgeons, Surgeon Volume varied widely, and a higher Volume was associated with less postoperative residual contracture, higher full release rates, and fewer adverse events. This implies that increasing Surgeon's procedure Volume provides an opportunity for improving the outcomes of Dupuytren's surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

  • Surgeon Volume and the Outcomes of Dupuytren's Surgery: Results from a Dutch Multicenter Study.
    Plastic and reconstructive surgery, 2018
    Co-Authors: Chao Zhou, Iris E Ceyisakar, Steven E R Hovius, Reinier Feitz, Harm P Slijper, Hester F Lingsma, Ruud W Selles
    Abstract:

    For many major surgical procedures, the outcomes are better when performed by Surgeons with higher procedure Volumes. The purpose of this study was to examine the relations between Surgeon procedure Volume and the outcomes of Dupuytren's surgery. The authors conducted an observational study from 2011 to 2014 at six dedicated hand surgery practice sites in The Netherlands. Five hundred eighty-eight patients underwent surgery for Dupuytren's contracture performed by one of the 16 Surgeons. The main exposure variable was annual Surgeon Volume. Outcome measures were the degree of residual contracture, full release rate, and any postoperative adverse event examined within 3 months of surgery. Mean annual Surgeon Volume was 51 among the 16 Surgeons(range; 4-86) procedures. The majority of patients had primary disease (79 percent) and underwent open fasciectomy (74 percent). Multivariable regression analyses showed that Surgeon Volume was linearly related to all three outcomes, and identified no optimal Volume threshold. Performing 10 additional procedures annually was independently associated with nearly 0.8 degree less residual contracture (p = 0.002), 9 percent higher odds of attaining a full release (p = 0.037), and 11 percent lower odds of an adverse event (p < 0.001). Nonetheless, patient-related factors had larger impacts on all three clinical outcomes than Surgeon Volume. In this study of practicing hand Surgeons, Surgeon Volume varied widely, and a higher Volume was associated with less postoperative residual contracture, higher full release rates, and fewer adverse events. This implies that increasing Surgeon's procedure Volume provides an opportunity for improving the outcomes of Dupuytren's surgery. Therapeutic, III.

  • Surgeon Volume Influences Treatment Outcome in the Dupuytren Disease Surgery
    HAND, 2016
    Co-Authors: Chao Zhou, Iris E Ceyisakar, Steven E R Hovius, Reinier Feitz, Harm P Slijper, Hester F Lingsma, Ruud W Selles
    Abstract:

    Objective: High Surgeon procedural Volume has been linked to better outcomes for a variety of surgical procedures, but the impact of Surgeon Volume on outcomes of Dupuytren surgery remains uncertain. Materials and Methods: We used data from a quality-of-care registry from 6 hand surgery practice sites between 2011 and 2014. We included 561 patients with the Dupuytren disease who underwent fasciectomy (71%) or percutaneous needle fasciotomy (29%) by 16 hand Surgeons. Outcomes were the degree of residual contracture and adverse events assessed at 6 to 12 weeks after treatment. Relations between Volume and outcomes were examined using linear and logistic regression models, with adjustment for patient characteristics and the type of procedure. Nonlinearity was assessed with restricted cubic splines. Results: Overall, mean residual contracture (total active extension deficit) at follow-up was 24°, which corresponded to a postprocedure improvement of 65%. Forty-seven percent of patients experienced at least 1 adverse event, with neuropraxia (12%), scar sequelae (12%), and wound healing problems (8%) being the three most common events. Surgeon Volume was inversely related to the degree of residual contracture: Every 58 additional procedures performed annually were associated with 5° less residual contracture at follow-up ( P, .03). Moreover, Surgeon Volume had an inverse effect on overall events (odds ratio per 50 additional procedures, 0.86, P, .01). Conclusions: Even among experienced hand Surgeons, patients treated by Surgeons performing high Volumes of Dupuytren surgery had better outcomes in terms of residual contracture and adverse events. The findings of this study suggest that Surgeons may improve outcomes by increasing their annual procedural Volume for these specific interventions.