TY  - JOUR
T1  - IMpact of surgeon and hospital caseload on the likelihood of performing laparoscopic vs open sigmoid resection for diverticular disease—invited critique
AU  - Stamos MJ
Y1  - 2007/03/01
N1  - 10.1001/archsurg.142.3.259
JO  - Archives of Surgery
SP  - 259
EP  - 259
VL  - 142
IS  - 3
N2  - 
First, it is noteworthy that 28 742 surgeons performed only 55 949 sigmoid colectomies over the sample of this database. Although the database is only a sample of 20% of patients undergoing these procedures, this study reveals what a true low-volume surgeon is! A high-volume surgeon is defined as one performing more than 15 sigmoid colectomies per year. This group of surgeons is apparently quite small, accounting for only 0.8% of the patients, whereas the low-volume surgeons (1-3 sigmoid colectomies per year) cared for almost 64% of the patients. Even if we expand the definition of a high-volume surgeon to as few as 7 sigmoid colectomies per year, only 10% of all patients would have been cared for by a high-volume surgeon. More interesting and perhaps worrisome is that 56% of the patients cared for by the low-volume surgeons were operated on urgently or emergently whereas only 21% of the patients cared for by the high-volume surgeons were operated on urgently or emergently. How can we explain this disparity? Numerous possibilities exist, including referral patterns, practice patterns, on-call responsibilities, and experience level to name a few. The net result is that any attempt to “corral” patients into the hands of a few high-volume surgeons or even high-volume hospitals is unlikely to succeed. Further, given the learning curve well accepted for laparoscopic colectomy, this article provides real estimates of the potential saturation of this technology in our current health care environment.

SN  - 0004-0010
M3  - doi: 10.1001/archsurg.142.3.259
UR  - http://dx.doi.org/10.1001/archsurg.142.3.259
ER  -