J. Danford1, D. Underbakke2, B. Sirovich1, S. Wong1,2, M. Sorensen1,2 1Geisel School of Medicine at Dartmouth,Hanover, NH, USA 2Dartmouth-Hitchcock Medical Center,General Surgery,Lebanon, NH, USA
Introduction: In the past 15 years, numerous investigators have demonstrated an association between surgeon volumes and outcomes. From this body of literature, there have been attempts to quantify minimum volume standards for specific surgeries. Despite the growing body of literature on the subject, little has been reported on the impact of this research on public perception of surgeon competency.
Methods: A survey on public perception of the importance of surgeon volumes was designed using a modified Delphi technique and completed by participants using Amazon Mechanical Turk, an online crowdsourcing marketplace. Respondents completed a 38-question survey on their opinion of minimum volume standards and other factors that may influence their choice of surgeon. They were also asked to estimate minimum volume standards for four different surgeries, and to consider the implications of published minimum volume numbers in two diagnostic scenarios.
Results: The survey was completed by 2,056 people. The respondents were 51% male, 49% female. Median age range was 30-39 years old.
Overall, 81% (n=1,666) of people agreed that surgeons should be subject to minimum volume standards. Only 19% (n=384) reported having prior knowledge about a link between surgeon volumes and outcomes.
Respondents accurately estimated the published suggested minimum volume standard for inguinal hernias of 25. For knee replacement surgery, respondents estimated a minimum of 30 per year: 1.5 times the published minimum volume standard of 20. For mitral valve repair, respondents estimated 44 per year: 4.4 times the published minimum volume standard of 10. For pancreaticoduodenectomy, respondents estimated 44 per year: 8.8 times the published minimum volume standard of 5.
When posed with the scenario of needing an inguinal hernia repair, 77% (n=1,584) said they would require their surgeon to have met a minimum volume standard to proceed with surgery. If told their surgeon performed 25 per year (the published suggested minimum volume standard), 55% (n=1,127) of respondents would feel comfortable proceeding with surgery. However, when posed with needing a pancreaticoduodenectomy, 92% (n=1,877) said they would require their surgeon to have met a minimum volume standard. And when told their surgeon did 5 per year (the established minimum volume standard), only 13% (n=265) would feel comfortable proceeding with surgery.
Conclusion: This survey suggests that surgical volumes are important to the lay public. However, it also demonstrates the general public’s unrealistic expectations of minimum volume standards and inability to interpret surgical volume numbers when attempting to use them to judge a surgeon’s competence. This study has implications for patients, surgeons, hospitals, and policy makers when considering the implementation of minimum volume standards and how best to educate the public about this aspect of choosing a surgeon.