Higher Surgical Volume Led to Better Patient Outcomes, Lower Costs

Orthopedic surgeons with higher surgical volume generated better patient outcomes and lower costs for hip and knee replacements, according to data from the healthcare analytics platform Clarify Health.

Surgical volume refers to the frequency with which surgeons and surgery centers perform complex surgical procedures. According to the Agency for Health Research and Quality (AHRQ), when seeking care, patients should ask their doctor how many times they have performed the procedure in question.

Higher-volume surgeons are expected to have fewer medical errors and defects and better acute outcomes overall. However, patients are not always able to consider surgical volume when selecting a provider for surgery.

The brief analyzed health insurance claims for patients undergoing total hip arthroplasties (hip replacements) and total knee arthroplasties (knee replacements) in 2021. Researchers used commercial claims data from 2017 to 2020 to calculate historical surgical volume.

The sample included over 66,000 hip replacements performed by 10,100 providers and 111,666 knee replacements performed by 13,432 providers.

Surgical volume varied among providers, the brief found. Around one-third of hip and knee replacement procedures were performed by surgeons with 100 or more prior surgeries, while 50 percent were done by surgeons who had completed less than 50 surgeries from 2017 to 2020.

Seventeen percent of hip replacements and 13 percent of knee replacements were performed by surgeons with less than 10 prior surgeries.

Higher surgical volume for a provider was associated with better patient outcomes for both hip and knee replacements.

Rates of post-acute inpatient readmissions at seven and 60 days were between 37 percent and 51 percent lower for surgeries with high-volume providers compared to those with low-volume providers.

Post-surgery inpatient days were 54 percent to 66 percent lower for surgeries with high-volume providers, and post-surgery emergency department (ED) visits were 23 percent to 38 percent lower.

High-volume surgeons were also associated with lower rates of revision surgeries and post-surgical stay orthopedic specialist visits.

These improved outcomes came at reduced costs as well. For example, total hip and knee episode costs were $2,800 and $1,500 lower, respectively, when high-volume surgeons performed the procedures over low-volume surgeons.

High-volume providers were associated with better outcomes regardless of the setting. Post-surgical ED visit rates were 21 percent lower in an inpatient setting, 35 percent lower in an outpatient setting, and 34 percent lower in an ambulatory surgical center (ASC) setting.

Similarly, readmission rates were reduced by 32 percent in an inpatient setting, 47 percent in an outpatient setting, and 74 percent in an ASC. Revision surgery rates for high-volume surgeons were also more minor in inpatient, outpatient, and ASC settings.

The relationship between surgical volumes and outcomes persisted even after researchers controlled for place of service, provider teaching affiliation status, provider state, patient demographics, and comorbidity status.

When assessing the connection separately for patients with comorbidities, such as metastatic cancer, obesity, chronic kidney disease, or hypertension, there was a stronger relationship between surgical volume and outcomes.

“We find that while surgical volume has benefits for all patients, the benefit of experienced surgeons increases for operations on higher acuity patients,” the brief stated.

The findings suggest that steering patients to high-volume providers could help avoid thousands of adverse clinical events each year.

However, many patients continue to see surgeons with lower surgical volumes. Patients may not be aware of the clinical difference surgical volume could make; if they are, there are few resources to help proactively identify high-volume surgeons.

According to the brief, healthcare stakeholders should set minimum surgical volume standards for in-network surgeons and educate surgeons on the importance of gaining sufficient experience during their medical training. In addition, stakeholders should educate consumers by releasing comprehensive information on surgical volumes that can help identify high-volume surgeons.