Does volume matter? The effect of XXXX surgeons' caseload on mortality.

@entity1 @entity258 @entity130
BACKGROUND: Evidence suggests that @entity130 centers treating high volumes of severely injured @entity1 produce lower mortality rates than those with low volumes. However, the effect of individual surgeons' @entity130 caseload on outcomes has not been studied. This study compares outcomes between high-volume (HV) @entity130 surgeons admitting many @entity1 with high injury severity, and @entity258 ( @entity258 ) surgeons treating fewer critical @entity1 per year. METHODS: All @entity130 @entity1 admitted to a large Level I @entity130 center over a 12-year period were assigned to either the HV or @entity258 group, depending on the yearly volume of their admitting surgeon. Surgeons treating > 35 severely injured (Injury Severity Score > 15) @entity1 per year were considered HV. Student's t test and chi2 analysis were used to test comparability of @entity258 and HV @entity1 groups and to compare mortality rates. Mortality rates of HV and @entity258 surgeons' @entity1 were compared in six injury patterns selected to represent moderate to severe injury. TRISS methodology (z score) was also used to assess outcomes in the two groups. The inherent bias of the TRISS method in comparing @entity130 outcomes was minimized by the homogeneity of the studied @entity1 population. RESULTS: A total of 16,481 @entity1 were admitted to HV surgeons, and 4,214 @entity1 were admitted to @entity258 surgeons. In all subgroups, HV and @entity258 @entity1 were similar regarding age, sex, physiologic status at admission, injury pattern, and injury severity. Mortality rates for HV and @entity258 surgeons were not significantly different between the two groups in any injury pattern. The z score was 1.88 in the HV @entity1 group versus 0.47 in the @entity258 group. CONCLUSION: Within a single institution, mortality rates for @entity1 treated by surgeons admitting many severely injured @entity1 were not significantly different from @entity258 surgeons' @entity1 , although there was a trend toward higher mortality in the less active surgeons' @entity1 in some subgroups.
