Evaluating cumulative and annual surgeon volume in laparoscopic cholecystectomy

Background. Although there is a large body of published data demonstrating improved outcomes for complex operations when performed by high-volume surgeons at high-volume hospitals, the literature is mixed regarding whether this same relationship applies in less complex and more common surgeries such as laparoscopic cholecystectomy. Methods. This study utilized the New York State Department of Health Statewide Planning and Research Cooperative System database to identify patients undergoing laparoscopic cholecystectomy for acute and chronic biliary pathology. Rates of perioperative outcomes were compared among 4 distinct categories of surgeons based on surgeon annual and cumulative volume: low cumulative/low annual, low cumulative/high annual, high cumulative/low annual, and high cumulative/high annual. Results. A total of 150,938 patients undergoing operation by 3,306 surgeons at 250 hospitals across New York state were included for analysis from 2000-2014. There was no difference in adjusted 30-day in-hospital mortality, major events, procedural complications, bile duct injury, or reintervention rates between the 4 groups of surgeons. However, patients undergoing operation by high cumulative/high annual volume surgeons were less likely to experience 30-day readmission, prolonged duration of stay, and high charges when compared with low cumulative/low annual volume surgeons. Conclusion. In New York state, increased surgeon annual and cumulative volume predicts lower rates of 30-day readmission, prolonged duration of stay, and high charges in laparoscopic cholecystectomy, but has no effect on in-hospital mortality, major events, bile duct injury, procedural complications, or reintervention. There is no evidence to support regionalization of this procedure as operative outcomes are comparable even in less experienced hands.