Most of us assume the answer to that question is obvious. The more times a surgeon performs an operation, the better the outcomes should be. But in our current healthcare system, “experience” is often categorized into high-volume or low-volume… without anyone agreeing on what those terms actually mean.
Over the weekend, I read a study that forced me to stop and reflect not just on the definitions and data, but also on my own surgical career.
The paper, “Is Quantity Quality? The Impact of Surgeon Volume on Outcomes in Inguinal Hernia Repair: A Quantitative Systematic Review,” examines re-operation and complication rates for groin hernia repairs based on a surgeon’s annual case volume.
At first glance, the results were not overwhelmingly convincing.
The re-operation rate for high-volume hernia surgeons was approximately 2.00%, while low-volume surgeons had a rate of 2.48%. While this difference reached statistical significance, the margin was low, raising an important question: If experience matters, why doesn’t the data show a more dramatic difference?
Well, let's break it down:
In this study, a high-volume hernia surgeon was defined as someone performing more than 50 hernia repairs per year. Medium volume was 25–50 cases annually, and low volume was fewer than 25.
Based on more than 20 years in practice, I’m not sure those definitions capture the reality of surgical expertise.