JAMA study shows that very low volume surgeons have worse outcomes and longer LOS for several vascular procedures

January 15, 2019

A study published in JAMA in August 2017 shows that for over 75,000 Abdominal Aortic Artery (AAA) repairs and Carotid Endarterectomies (CEA), outcomes of very low volume surgeons were significantly worse. The study was for all cases in NY state from 2000-2014. Very low volume surgeons were defined as those averaging one or less of these cases per year. Despite this low threshold, approximately 50% of surgeons met this description. For these surgeons, mortality and major complications was higher than for other surgeons. In addition, length of stay (for AAA) and 30-day readmission rate (for CEA) was higher for the low volume surgeons.

EHC Note: As with any other complex, process-oriented endeavor, surgical outcomes are likely to improve with repetition and experience. The fact that about 50% of the surgeons in the referenced study average one or less of these complex procedures should shine a light on this issue for all providers and facilities. In our opinion, this issue extends also to OR and floor nursing as well as other support staff. Repetition reinforces, refines and perfects processes. If you are a “very low volume institution” for any complex procedures, take a close look at risk adjusted outcomes. It may make sense to focus on surgical areas where your facility has adequate volume to maintain the skill set and expertise of your providers.