Effect of surgeon and anesthesiologist volume on surgical outcomes.
BACKGROUND
Little is known regarding the effects of caseload volume of other relevant members of the "surgical team." The present study sought to report variations in health care utilization and outcomes relative to surgeon and anesthesiologist volume among patients undergoing pancreatic surgery.


METHODS
A total of 969 patients undergoing pancreatic surgery from 2011-2013 were identified at a large, tertiary care center. Multivariable regression analyses explored the effects of provider volume on crystalloid administration, blood transfusions, mortality, length of stay, and hospital charges.


RESULTS
A total of 11 surgeons were identified while 100 anesthesiologists were involved in providing care to all patients. Annual case volume for surgeons ranged from 5-101 pancreatic resections per year; each anesthesiologist was involved in a fewer number of cases per year with a maximum of 15 patients treated by the same anesthesiologist. Higher volume surgeons had higher transfusions (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.38-2.47; P < 0.001), greater crystalloid administration (OR, 1.62; 95% CI, 1.24-2.12; P < 0.001), and longer length of stay (OR, 1.74; 95% CI, 1.20-2.53; P = 0.003). In contrast, 30-d readmission was lower among higher volume surgeons (low volume versus high volume; 23.1% versus 11.6%; P < 0.001). Variations in patient-related outcomes were not associated with anesthesia provider volume (all P > 0.05). Similarly, total hospital charges and mortality were not associated with provider volumes (both P > 0.05).


CONCLUSIONS
Although variability exists in health care practices among providers at the surgeon level, less is observed among anesthesiologists. Although a proportion of this variability can be explained by provider volumes, a significant proportion remains unexplained possibly due to nonmodifiable factors such as patient case mix.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Faiz
F
Gani
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Yuhree
Y
Kim
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Matthew J
MJ
Weiss
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Martin A
MA
Makary
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Christopher L
CL
Wolfgang
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Kenzo
K
Hirose
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
John L
JL
Cameron
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jack O
JO
Wasey
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Steven M
SM
Frank
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000368:Aged; D000776:Anesthesiology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*
Anesthesiologist; Provider variation; Provider volume; Surgeon; Variation