Evidence Based Studies

More procedure experience often means safer surgery and smoother recovery.

Summary

Peer reviewed evidence indicates that, for many operations, higher surgeon and hospital procedure volume is associated with fewer serious complications and lower short term mortality, but it does not guarantee results for any individual patient. Large population studies in the United States found lower operative mortality among higher volume surgeons and hospitals after adjustment for patient risk. Systematic reviews conclude that the direction of the volume outcome association is common across procedures, yet heterogeneous and limited by observational designs, residual confounding, and selective referral. In orthopedic joint replacement, studies and reviews report trends toward lower infection, transfusion, dislocation, readmission, and length of stay, and in some cohorts better function, when procedures are performed by higher volume surgeons and/or at higher volume centers. Some outcomes (for example, long term implant survivorship) show weaker or inconsistent volume signals, highlighting that volume is a proxy for multiple factors: technical repetition, team experience, perioperative pathways, and complication management. Overall, the literature supports using procedure specific experience as one informative quality signal to consider alongside patient fit, access, and shared decision making for complex procedures.

Bibliography

  1. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137(6):511-520. doi:10.7326/0003-4819-137-6-200209170-00012.
  2. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128-1137. doi:10.1056/NEJMsa012337.
  3. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117-2127. doi:10.1056/NEJMsa035205.
  4. Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res. 2007;457:35-41. doi:10.1097/BLO.0b013e3180375514.
  5. Lau RL, Perruccio AV, Gandhi R, Mahomed NN. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord. 2012;13:250. doi:10.1186/1471-2474-13-250.
  6. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86(9):1909-1916. doi:10.2106/00004623-200409000-00008.
  7. Katz JN, Mahomed NN, Baron JA, Barrett JA, Fossel AH, Creel AH, Wright J, Wright EA, Losina E. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum. 2007;56(2):568-574. doi:10.1002/art.22333.
  8. Ravi B, Jenkinson R, Austin PC, Croxford R, Wasserstein D, Escott B, Paterson JM, Kreder H, Hawker GA. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ. 2014;348:g3284. doi:10.1136/bmj.g3284.
  9. Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty. 2018;33(10):3329-3342. doi:10.1016/j.arth.2018.05.040.
  10. Siddiqi A, Alamanda VK, Barrington JW, Chen AF, De A, Huddleston JI 3rd, Bozic KJ, Lewallen D, Piuzzi NS, Mullen K, Porter KR, Springer BD. Effects of hospital and surgeon volume on patient outcomes after total joint arthroplasty: Reported from the American Joint Replacement Registry. J Am Acad Orthop Surg. 2022;30(11):e811-e821. doi:10.5435/JAAOS-D-21-00946.
Methodology Contact Us