The importance of surgeon volume and training in outcomes for vascular surgical procedures

Pearce, William H.; Parker, Michele; Feinglass, Joe; Ujiki, Michael; Manheim, Larry M.

doi:10.1016/s0741-5214(99)70202-8

Cited by 264 publications

(213 citation statements)

References 20 publications

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“…The main change to the surgical structure over the period was the establishment of a regional vascular unit based at the South Tees area where previously the unit had been local. However, improvements in surgeon volume does not benefit lower extremity arterial surgery in terms of outcomes in the same way as other vascular procedures, such as carotid endarterectomy and abdominal aortic aneurysm repair, and may actually lead to an increase in procedure rates (29). We have not classified the etiology of the LEA in terms of ischemic, neuroischemic, or neuropathic.…”

Section: Likely Explanations Of Resultsmentioning

confidence: 97%

Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care

Canavan

Unwin²,

Kelly³

et al. 2008

Diabetes Care

194

170

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OBJECTIVE -There is a lack of continuous longitudinal population-based data on lower extremity amputation (LEA) in the U.K. We present here accurate data on trends in diabetesrelated (DR) LEAs and non-DRLEAs in the South Tees area over a continuous 5-year period.RESEARCH DESIGN AND METHODS -All cases of LEA from 1 July 1995 to 30 June 2000 within the area were identified. Estimated ascertainment using capture-recapture analysis approached 100% for LEAs in the area. Data were collected longitudinally using the standard method of the Global Lower Extremity Amputation Study protocol.RESULTS -Over 5 years there were 454 LEAs (66.3% men) in the South Tees area, of which 223 were diabetes related (49.1%). Among individuals with diabetes, LEA rates went from 564.3 in the first year to 176.0 of 100,000 persons with diabetes in the fifth year. Over the same period, non-DRLEAs increased from 12.3 to 22.8 of 100,000 persons without diabetes. The relative risk of a person with diabetes undergoing an LEA went from being 46 times that of a person without diabetes to 7.7 at the end of the 5 years. The biggest improvement in LEA incidence was seen in the reduction of repeat major DRLEAs.CONCLUSIONS -Our data show that in the South Tees area at a time when major non-DRLEA rates increased, major DRLEA rates have fallen. These diverging trends mark a significant improvement in care for patients with diabetic foot disease as a result of better organized diabetes care.

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Section: Likely Explanations Of Resultsmentioning

confidence: 97%

Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care

Canavan

Unwin²,

Kelly³

et al. 2008

Diabetes Care

194

170

View full text Add to dashboard Cite

show abstract

“…Prystowsky et al [8] reported that American Board of Surgery certification was associated with reduced mortality and morbidity for colorectal resection. Pearce et al [9] found that surgeons with a subspecialty certification had better outcomes for carotid endarterectomy and abdominal aortic aneurysm repair. More interestingly, Avital et al [10] reported that adequate oncologic resections in laparoscopic treatment might be achieved earlier, provided that surgeons adhere to open standard cancer resection methods.…”

Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

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“…[6][7][8] This surely contributes to good surgical results, as it has been shown that high-volume surgeons (more than 60 surgeries per year) have fewer surgical complications [18] and that the results of carotid endarterectomy are better if performed exclusively by vascular surgeons. [19] Furthermore, it appears that the choice of surgical technique may also play a role as it has been suggested that ECEA may be associated with lower risk of arterial occlusion and restenosis than longitudinal arteriotomy.…”

Section: Discussionmentioning

confidence: 99%

Eversion Carotid Endarterectomy in Patients with Near-Total Internal Carotid Artery Occlusion - Diagnostic Modalities, Indications and Surgical Technique

Radak¹,

Tanasković²

2012

Vascular Surgery

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The importance of surgeon volume and training in outcomes for vascular surgical procedures

Cited by 264 publications

References 20 publications

Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care

Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot Care

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Eversion Carotid Endarterectomy in Patients with Near-Total Internal Carotid Artery Occlusion - Diagnostic Modalities, Indications and Surgical Technique

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