Back to 2017 Program
Is Annual Surgical Volume Enough? The Role of Experience and Specialization on Inpatient Mortality Following Hepatectomy
Daniel A Hashimoto, Yanik J Bababekov, Sahael M Stapleton, Keith D Lillemoe, David C Chang, Parsia A Vagefi
Massachusetts General Hospital, Boston, MA
The impact of annual surgical volume on post-operative outcomes has been extensively examined. However, the impact of cumulative surgeon experience and specialty training on this relationship warrants investigation.
The New York Statewide Planning and Research Cooperative System inpatient database was queried for patients ≥18 years who underwent wedge hepatectomy or lobectomy from 2000-2014. Patient data included demographics and comorbidities. Surgeon-specific data included annual hepatectomy volume, experience [early-career vs. late-career (<20 vs. ≥20 years since medical school graduation, respectively)], and specialty training (general, transplant, or oncologic). Adjusting for both patient and surgeon factors, multiple logistic regression was performed to identify predictors of the primary endpoint - inpatient mortality.
13,467 cases were analyzed. Overall inpatient mortality was 2.35% and was significantly lower among surgeons with >30 cases per year (1.5% vs. 3.1%, p<0.001). In unadjusted analysis, this difference appeared to persist in early-career (1.2 vs. 2.8%, p<0.001) and late-career surgeons (1.8% vs. 3.2%, p<0.001). However, once risk-adjusted, annual volume was associated with reduced mortality only among early-career surgeons (OR 0.826, p=0.01) and general surgeons (OR 0.685, p=0.01). No volume effect was seen among late-career or specialty-trained surgeons.
Cumulative experience and specialty training offset the effect of annual volume on inpatient mortality following hepatectomy, demonstrating that annual surgical volume alone is a poor surrogate for overall experience. Furthermore, this study highlights the need for longitudinal coaching of early-career surgeons by experienced faculty and the importance of fellowship training in hepatic surgery.
Back to 2017 Program