TY - JOUR
T1 - Effect of surgeon and anesthesiologist volume on surgical outcomes
AU - Gani, Faiz
AU - Kim, Yuhree
AU - Weiss, Matthew J
AU - Makary, Martin A.
AU - Wolfgang, Christopher L.
AU - Hirose, Kenzo
AU - Cameron, John L.
AU - Wasey, Jack O.
AU - Frank, Steven M.
AU - Pawlik, Timothy M.
N1 - Funding Information:
Authors? contributions: T.M.P. and F.G. had full access to all the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis, did the drafting of the article. F.G., Y.K., S.M.F., and T.M.P. contributed to the study concept and design. F.G., S.M.F., and T.M.P. did the acquisition of data. F.G., Y.K., and T.M.P. did the analysis and interpretation. F.G., Y.K., M.J.W., M.A.M., C.L.W., K.H., J.L.C., J.O.W., S.M.F., and T.M.P. did the critical revision.
PY - 2016/2
Y1 - 2016/2
N2 - Background: Little is known regarding the effects of caseload volume of other relevant members of the “surgical team.” The present study sought to report variations in health care utilization and outcomes relative to surgeon and anesthesiologist volume among patients undergoing pancreatic surgery. Methods: A total of 969 patients undergoing pancreatic surgery from 2011–2013 were identified at a large, tertiary care center. Multivariable regression analyses explored the effects of provider volume on crystalloid administration, blood transfusions, mortality, length of stay, and hospital charges. Results: A total of 11 surgeons were identified while 100 anesthesiologists were involved in providing care to all patients. Annual case volume for surgeons ranged from 5–101 pancreatic resections per year; each anesthesiologist was involved in a fewer number of cases per year with a maximum of 15 patients treated by the same anesthesiologist. Higher volume surgeons had higher transfusions (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.38–2.47; P < 0.001), greater crystalloid administration (OR, 1.62; 95% CI, 1.24–2.12; P < 0.001), and longer length of stay (OR, 1.74; 95% CI, 1.20–2.53; P = 0.003). In contrast, 30-d readmission was lower among higher volume surgeons (low volume versus high volume; 23.1% versus 11.6%; P < 0.001). Variations in patient-related outcomes were not associated with anesthesia provider volume (all P > 0.05). Similarly, total hospital charges and mortality were not associated with provider volumes (both P > 0.05). Conclusions: Although variability exists in health care practices among providers at the surgeon level, less is observed among anesthesiologists. Although a proportion of this variability can be explained by provider volumes, a significant proportion remains unexplained possibly due to nonmodifiable factors such as patient case mix.
AB - Background: Little is known regarding the effects of caseload volume of other relevant members of the “surgical team.” The present study sought to report variations in health care utilization and outcomes relative to surgeon and anesthesiologist volume among patients undergoing pancreatic surgery. Methods: A total of 969 patients undergoing pancreatic surgery from 2011–2013 were identified at a large, tertiary care center. Multivariable regression analyses explored the effects of provider volume on crystalloid administration, blood transfusions, mortality, length of stay, and hospital charges. Results: A total of 11 surgeons were identified while 100 anesthesiologists were involved in providing care to all patients. Annual case volume for surgeons ranged from 5–101 pancreatic resections per year; each anesthesiologist was involved in a fewer number of cases per year with a maximum of 15 patients treated by the same anesthesiologist. Higher volume surgeons had higher transfusions (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.38–2.47; P < 0.001), greater crystalloid administration (OR, 1.62; 95% CI, 1.24–2.12; P < 0.001), and longer length of stay (OR, 1.74; 95% CI, 1.20–2.53; P = 0.003). In contrast, 30-d readmission was lower among higher volume surgeons (low volume versus high volume; 23.1% versus 11.6%; P < 0.001). Variations in patient-related outcomes were not associated with anesthesia provider volume (all P > 0.05). Similarly, total hospital charges and mortality were not associated with provider volumes (both P > 0.05). Conclusions: Although variability exists in health care practices among providers at the surgeon level, less is observed among anesthesiologists. Although a proportion of this variability can be explained by provider volumes, a significant proportion remains unexplained possibly due to nonmodifiable factors such as patient case mix.
KW - Anesthesiologist
KW - Provider variation
KW - Provider volume
KW - Surgeon
KW - Variation
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U2 - 10.1016/j.jss.2015.08.010
DO - 10.1016/j.jss.2015.08.010
M3 - Article
C2 - 26342836
AN - SCOPUS:85027952912
SN - 0022-4804
VL - 200
SP - 427
EP - 434
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 2
ER -