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Saturday, October 19th 2013

Volume Makes Better Outcomes

Don’t listen to Lombardi. Practice eventually makes people good at a skill. Even over practicing. I used to have this impression in surgical training that the learning curve was steep but then tapered off. That perhaps, once you reached a relatively low threshold that improvement beyond that would happen but be marginal. That perhaps there wasn’t much of a difference between the 100th brain tumor and the 500th brain tumor from the same approach for a medical system – the surgeon and the OR staff and the nursing caring for the patients.

I don’t believe that anymore.

Some of the most important questions you can ask a proceduralist are how many of your type of surgery he’s done (being specific) and how often he performs them at whatever hospital or surgical center you’re going to be at.

Just more evidence for such in the NEJM. For six index surgeries,

Hospitals with high surgical volume and low surgical mortality have lower rates of surgical readmission than other hospitals.

Kind’ve obvious but worth reminding. The literature is full of evidence that volume makes better outcomes whether it’s in heart attacks or colon surgery.