Threshold volumes for urological cancer surgery: a survey of UK urologists.
OBJECTIVE
To determine minimum threshold levels of activity set by surgeons for urological cancer surgery, and to relate threshold levels to stated current procedural volume.


METHODS
In all, 307 consultant urological surgeons were sent a questionnaire asking them to state for four urological cancer operations of different complexity their current procedural volume; whether minimum volume thresholds per surgeon should be implemented; and if so, the level of such thresholds; 212 (69%) replied.


RESULTS
For all four procedures >/= 75% of surgeons advocated the setting of a minimum volume threshold. Overall, surgeons set the highest thresholds for radical prostatectomy and the lowest for radical cystectomy with continent diversion. There was no significant association between either the principle of supporting minimum volume thresholds or the level of such a threshold and the number of years worked as a consultant surgeon. The level of surgeon-derived minimum thresholds increased with increasing surgeon procedural volume.


CONCLUSIONS
Most surgeons supported the principle of setting minimum volume thresholds. These thresholds appear to be influenced by current procedural volume and by procedural complexity. By setting thresholds greater than their current volume, some surgeons implicitly indicate that their current volume is insufficient to maintain their surgical competency.
Nuttall
Martin C
MC
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK. mnuttall@rcseng.ac.uk
van der Meulen
Jan
J
McIntosh
Gregor
G
Gillatt
David
D
Emberton
Mark
M
D002983:Clinical Competence / Q000592:standards*; D003253:Consultants; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D006113:United Kingdom; D014571:Urologic Neoplasms / Q000601:surgery*; D014572:Urology / Q000592:standards / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*