Surgical Volume Matters

Surgical Volume Matters
Dr. William Joseph Bose Orthopedist Mobile, AL

Dr. William Bose is an orthopaedic surgeon practicing in Mobile, AL. Dr. Bose specializes in the diagnosis, treatment and rehabilitation of injuries, diseases and disorders of the bodys musculoskeletal system. As an orthopaedic surgeon, Dr. Bose tends to bones, ligaments, muscles, joints, nerves and tendons. Orthopaedic... more

Many, many factors come together to obtain an excellent outcome for the patient after orthopedic surgery. Patient expectations and attitudes, and medical diseases all play a role. However, the skill of the surgeon also plays a significant role. Research has shown time and time again that if a surgeon performs a high volume of a particular procedure, (such as hip, knee or shoulder replacements) the patient is more likely to have better results after surgery.

Just like hitting a golf ball, shooting a basketball or playing quarterback in football, surgery is a learned skill, and over time, perfect practice makes perfect. Orthopaedic surgeon Dr. Carlos Lavernia of Miami was the first to show a direct statistical association between high surgical volume and improved outcomes after hip and knee replacement surgery.  He is however quick to admit that high volume does not automatically imply quality. Most believe there is  improvement in the overall efficiency for which a procedure is done, and a surgeon improves as he does more surgery. The reduction of surgical time, less tissue damage and less blood loss are believed to be all related to how adept a surgeon is in doing a particular procedure and therefore a good surgical result.  

In contrast, many studies that show that low volume surgeons have an increase in hip dislocation rate, higher infection, and an increase in blood clots after a total hip replacement. In a  recent study of 18,000 Canadians who underwent a hip replacement, showed that surgeons who performed less than 35 replacements per year had a higher dislocation rate.  Another study of 58,000 US Medicare patients showed that surgeons who did more that 50 cases per year had better outcomes that surgeons who did ten or less hip replacements per year. I advise patient that have arthritis of the hip, knee or shoulder to ask their surgeon about their surgical volume for a particular procedure. Choose a surgeon who performs at least 50 hip or knee replacements per year to improve your chances of a good outcome.

In my opinion, there another factor which must be accounted for. In order to get consistent good results after surgery, the surgeon must have excellent decision making skills. He knows what to do at the right time, and what to avoid in order to stay out of trouble. Experience through repetition and high volume are the only things that will give a surgeon great decision making skills. After over 3000 knee replacements and 3000 hip replacements, my decision making skills are much better than they were after my earlier surgeries. This is similar to a football quarterback. It takes 3-4 years before most NFL quarterbacks have good decision making skills to become a really good quarterback.

Finally a surgeon who gets consistent good results must be critical of himself. Only by being honest and critical of your work, can you identify areas that can be improved.  Personally, I am my harshest critic. I continually strive to improve my skills (by going to surgical instruction courses) and decision making in the hope that it will lead to better results for my patients. My patients deserve the best that I can provide.