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 21 May 2018

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News

Surgeon volume is a poor proxy for skill in esophageal cancer surgery

Surgeon volume is a poor proxy for skill in esophageal cancer surgery, finds the latest issue of Annals of Surgery.

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Dr Martin Rutegård and colleagues from Sweden evaluated the impact of surgeon volume on the risk of technical surgical complications after esophageal cancer resection.

The team found severe postoperative complications occur in about half of esophagectomized patients.

Of these, technical complications might be particular targets for improvement.

Population-based studies of the influence of surgeon volume on technical complications are sparse.

The team conducted a prospective, nationwide, population-based study in Sweden in 2001 through 2005.

25% of patients had at least 1 technical surgical complication
Annals of Surgery

Details concerning patient and tumor characteristics, surgical procedures, and predefined complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register.

The surgeon volume cut-offs of less than 2, 2 to 6, and more than 6 operations per annum were predefined on the basis of previous research.

The researchers found that among 615 patients undergoing esophageal resection for cancer, 25% patients sustained at least 1 technical surgical complication.

No association was found between high-volume surgery and decreased risk of such complications.

Compared with high-volume surgeons, the team noted that medium-volume surgeons had an adjusted odds ratios of 0.8.

Low-volume surgeons had an odds ratio of 0.99 for occurrence of any technical surgical complication.

Differences were found between individual high-volume surgeons regarding crude risk of anastomotic leakage, and secondary surgical complications.

Dr Rutegård‘s team concluded, “Surgeon volume seems to be a poor proxy for skill in esophageal cancer surgery.”

“Other factors might be of more importance, as indicated by variations in outcome between individual experienced surgeons.”

 

Ann Surg 2009: 249(2): 256-61


18 February 2009

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