Kneeling for the pledge.

Top Line: Higher volume surgeons and hospitals produce better clinical outcomes, right? 

The Study: This concept has led several large health systems to make the “Volume Pledge” whereby high-risk surgical procedures are performed at facilities and by surgeons who meet certain volume thresholds. Lung cancer resection is one of those procedures. This retrospective analysis of the Society of Thoracic Surgeons’ (STS) large Thoracic Surgery Database compared short-term clinical outcomes for patients undergoing lung cancer resection based on whether their hospital and/or surgeon met Volume Pledge minimum thresholds (40 cases per year for hospital, 20 per year for surgeon). The study included well over 30,000 patients, nearly 500 surgeons, and over 200 hospitals. Just over half (52%) of patients had surgery by a consistently high-volume surgeon at a consistently high-volume hospital. There was no association between high-volume status and operative mortality, complications, or morbidity. The problem is that a rather arbitrary, dichotomous case threshold is simple to enact, but it fails to account for the complexities of high-risk surgical care. Compared to hospitals, there was an apparent inverse linear relationship between surgeon volume and outcome. The problem, though, is that only 8% of surgeons met the 60 case/year threshold to see better outcomes. 

TBL: “Volume Pledge” minimum case thresholds are not associated with improved patient outcomes for lung cancer resection. | Farjah, J Clin Oncol 2020

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