Surgical volumes (how many pancreatectomies a surgeon does) and surgical specialism (what proportion of the surgeon’s operations are pancreatectomies) are separate, albeit correlated, variables. The question about volume has been well studied and, up to a point, technically demanding procedures yield better results in the hand of high-volume practitioners. But what about specialism, net of volume; do surgeons who carry out 50 pancreatic surgeries a year and lots of other operations get better results than those who do pancreatic surgeries and little else? The CLAHRC WM Director would have answered ‘yes’ to that question, on the grounds that the less specialised surgeons will have more opportunities to exercise and refine the generic operating skills of suturing and dissection. Surprisingly a study based on nearly 700,000 patients undergoing one of eight major operations, and over 25,000 surgeons found, net of volume, lower deaths or readmission rates among high- rather than low-specialisation surgeons. The authors attribute their findings to the cognitive load inherent in switching from one procedure to another. However, there was no control for the age of the surgeon. The CLAHRC WM Director has noticed that as surgeons age, they tend to reduce their operative oeuvre. They may feel less concerned about restricting their range of practice as the end of their clinical life approaches, or they may acquire managerial or other duties that force them to be more selective in what they do. The CLAHRC WM Director suspects that the age of the surgeon is included in the Medicare database used in this study, and suggests that the authors perform this secondary analysis.
— Richard Lilford, CLAHRC WM Director
- Sahni NR, Dalton M, Cutler DM, BIrkmeyer JD, Chandra A. Surgeon specialization and operative mortality in United States: retrospective analysis. BMJ. 2016; 354: i3571.