Traditionally, overall surgeon experience has been used as an indicator of a surgeon’s skill. However, the argument can be made that the percentage of a surgeon’s operations that involve a specific procedure is just as important. This percentage is a surgeon’s specialization and was shown to be useful in predicting patient mortality.
A surgeon’s overall experience is a good indicator of their skill in an operating room. This is fairly intuitive, as someone who has performed a procedure more times is more likely to be proficient in said procedure. However, an equally important indicator of a surgeon’s skill in a given procedure could be their specialization, or how frequently the surgeon performs the procedure. The muscle memory developed by performing an operation frequently without having to switch between different procedures could lead to a more effective surgery and a better patient outcome. This rationale was the basis behind the study by Sahni et al., which examined the effects of a surgeon’s specialization in specific procedures on patient mortality.
The study, published in the British Medical Journal, investigated surgeon specialization independent of surgeon procedure volume and how it affects patient outcome. Eight common operations were examined, four cardiovascular procedures and four cancer resections, with data drawn from Medicare files. Patients had to be 66 years or older and the procedure had to be done within 3 days of admission to avoid potential adverse effects from surgery delays. Patient mortality was measured as patient death within 30 days of initial admission, with controls for factors such as: time between admission and surgery, surgeon experience and hospital quality. Surgeons were divided into quarters based on both procedure specialization and procedure volume. After statistical analysis, researchers found that in six of the eight procedures studied, patient mortality was significantly linked to surgeon specialization. Surgeon volume was controlled for, and in five of the eight procedures, selecting a surgeon from the top quarter of procedure specialization yielded a greater risk reduction compared to selecting a surgeon from the top quarter of procedure volume. This improvement in procedure quality is likely due to increased motor skills from repetition and familiarity with medical instruments.
The results of this study have broad implications on patient care and the availability of information. Case distribution and referrals should be impacted by the finding that a surgeon’s specialization in a given procedure can be more important than their overall experience. It should also be considered whether patients should be given access to this information to allow for a more informed decision. Further studies should be done to examine if this relationship still holds true in: other procedures, similar surgeries that are not the exact same procedure and if the relationship holds true in non-surgical settings, such as chronic treatment. Overall, the findings suggest that surgeon specialization is an important factor in deciding what surgeon is best suited for a procedure.
Written By: Wesley Tin BMSc