The phrase “practice makes perfect” has never been more true than in surgery. Research shows that better outcomes are associated with an increased procedure volume. While practicing and completing procedures can affect patient outcomes, the British Medical Journal (BMJ) has found that specializing in a specific procedure may be just as important as the number of times you perform it.
The benefits of specialization
Surgeons who specialize in one procedure are likely to have better outcomes because of:
- Muscle memory built from repetitious activity.
- Higher attention and faster recall as a result of not switching among procedures.
The effects of specialization on patient outcome
To reach this conclusion, researchers looked at data from Medicare on these eight procedures:
- carotid endarterectomy
- coronary artery bypass grafting
- valve replacement
- abdominal aortic aneurysm repair
- lung resection
- cystectomy
- pancreatic resection
- esophagectomy
They also examined statistics on nearly 700,000 patients and over 25,000 surgeons who completed one of the eight procedures. Researchers found that patients were less likely to die if their surgeon was highly specialized in a procedure, and that level of specialization was a key indicator of mortality risk, not how many times a surgeon had performed a procedure.
Additional findings
The specialization advantage doesn’t apply to every procedure, however. Researchers found some procedures show diminishing “learning by doing” returns after a certain level of “doing”—like abdominal aortic aneurysm repair.
In addition to the muscle memory and faster recall that specializing surgeons experience, researchers found these surgeons’ increased familiarity with medical devices and ability to perform procedures on a diverse range of patient circumstances contributed to decreased mortality rates.
Researchers discovered those cardiovascular surgeons who were in the top quarter of specialization saw a significant reduction in mortality compared to those surgeons in the bottom quarter.
According to Cardiovascular Business: “The relative risk reduction in 30-day operative mortality between the bottom and top quarters of surgeons was 35 percent with CABG, 18 percent with carotid endarterectomy, 74 percent with abdominal aortic aneurysm repair and 22 percent with valve replacement.”
What to expect from the results
The findings could have implications for several groups, including physicians, patients, policy makers and administrators, according to the study’s authors.
They suggest:
- A hospital administrator determining case distribution could use the information to consider not only a “surgeon’s volume in that procedure but also his or her degree of specialization.”
- Policy makers could use surgeon specialization to assign patients to surgeons to improve quality in rural or smaller hospitals where surgeons cannot meet minimum volume thresholds.
- A physician could possibly improve patient outcomes by considering the measure of surgeon specialization when referring patients.
- If the data was made available to patients, they could choose a surgeon who could improve their chances of survival.
