title: The influence of volume and experience on individual surgical performance: a systematic review.
abstract: OBJECTIVE
  To systematically review studies evaluating the influence of surgical experience on individual performance.
  
  
  BACKGROUND
  Experience, measured in case volume or years of practice, is recognized as a key driver of individual surgical performance, giving rise to a learning curve. However, this topic has not been reviewed at the cross-specialty level.
  
  
  METHODS
  MEDLINE, EMBASE, PsycINFO, AMED, and the Cochrane Database of Systematic Reviews were searched (from inception to February 2013). Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Ninety-one data points per study were extracted.
  
  
  RESULTS
  The search strategy yielded 6950 citations. Fifty-seven studies were eligible, including 1,061,913 cases and 35 procedure types, performed by 17,912 surgeons. Forty-five studies monitored case volume, and 6 studies measured experience as both case volume and years of practice. Of these 51 studies, 44 found that increased case volume was associated with significantly improved health outcomes. Several studies noted a plateau phase or maturation in the surgical learning curve. Acquisition of this phase was procedure specific and outcome specific, ranging from 25 to 750 procedures. Twelve studies assessed the impact of years of surgical practice, 11 of which found that increased years of experience was associated with significantly improved health outcomes. Two studies noted a plateau phase, where increases in years of experience were no longer associated with improvements in operative outcomes. Three studies identified performance deterioration after the plateau phase.
  
  
  CONCLUSIONS
  Increasing surgical case volume and years of practice are associated with improved performance, in a procedure-specific manner. Performance may deteriorate toward the end of a surgeon's career.
authors: *Harvard University, Cambridge, MA †Imperial College London, London, United Kingdom ‡Department of Surgery, University of Oxford, and IDEAL Collaboration, John Radcliffe Hospital, Oxford, United Kingdom §Public Health, Universite de Lyon, Lyon, France; and ¶Department of Surgery, Harvard Medical School, Boston, MA.
authors: Mahiben
authors: M
authors: Maruthappu
authors: Barnabas J
authors: BJ
authors: Gilbert
authors: Majd A
authors: MA
authors: El-Harasis
authors: Myura
authors: M
authors: Nagendran
authors: Peter
authors: P
authors: McCulloch
authors: Antoine
authors: A
authors: Duclos
authors: Matthew J
authors: MJ
authors: Carty
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011214:Practice, Psychological; D013514:Surgical Procedures, Operative / Q000193:education / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013647:Task Performance and Analysis