How Your Surgeon’s Experience Impacts Surgical Success: What You Need to Know
If your doctor has recommended surgery, there are two important steps you should take before agreeing to undergo any procedure. First, seek a second opinion from a physician who has extensive experience treating people with your diagnosis. A second opinion can change or confirm your diagnosis and treatment plan and may provide you with other, non-surgical options to treat your condition.
It may be helpful to consult not only with another surgeon, who can tell you whether they agree with the surgery recommendation and the proposed surgical approach, but also with a non-surgical specialist, for example a cardiologist rather than a cardiothoracic surgeon. The non-surgical specialist may suggest trying medication to manage and potentially improve your condition, lifestyle changes, or in the case of orthopedic and spine conditions, physical therapy. If these approaches do not achieve the results you’re seeking, then you can proceed to surgery. In most cases, elective (non-emergency) surgery shouldn’t be the first treatment you try.
Surgeon experience can significantly impact outcomes
If you decide to have surgery, your next step should be to learn as much as you can about your surgeon’s experience and the number of procedures the surgeon performs each year. Several studies and analyses have found that physicians who do not perform a procedure frequently have higher rates of post-surgical complications and deaths.
Studies and meta-analyses have found an association between surgeon experience and outcomes, noting decreased post-surgery mortality after colon resection performed by higher volume surgeons. The study authors also noted that board certification of the surgeon was associated with lower rates of post-surgical mortality and morbidity.
Other researchers found that Medicare patients treated by younger, less experienced surgeons had poorer outcomes than those treated by older, more experienced surgeons. Patients of new surgeons (average experience 1.6 years) had 42% higher odds of 30-day mortality than patients of more experienced colleagues (average experience 21.3 years). The study authors noted, however, that there were additional factors at play. A larger percentage of the patients treated by the less experienced surgeons entered the system through the emergency department and tended to be older (age 85 +), which increases the overall risk of poor outcomes.
A report from The Leapfrog Group, an independent healthcare safety organization, concluded that physicians and hospitals should perform a certain number of any given procedures each year to increase patient safety and improve outcomes. The report focused on total hip and knee replacement and bariatric surgery. Both the total volume of these surgeries performed at the hospital and the total number performed by an individual surgeon were considered.
The minimum recommended facility volume for all three types of surgery was 50 per year. For surgeons, the minimum annual volume for hip and knee replacement was 25 and 20 for bariatric surgery. The reason facility volumes are also considered is that the outcome of surgery is not only affected by the surgeon, but also by factors including anesthesia and post-surgery care.
An additional factor that can influence surgical outcomes is continuity of care. One study noted an association between fragmented care and an increase in poorer outcomes, especially for high risk surgery patients. Fragmented care was also linked to an increase in readmissions to the hospital. Having a health advisor who can provide all your treating physicians with a carefully reviewed and updated medical record can help lower the risk of care fragmentation.
Ask these questions before choosing a surgeon
You have a key role to play in choosing a surgeon. While your primary care physician or a specialist may recommend a surgeon, you should also take the time to talk with the surgeon and learn as much as possible about his or her experience, complication rates, outcomes, and your range of treatment options. Your health advisor can also connect you with experienced surgeons.
As part of your conversation with the surgeon, ask these questions:
- Expertise: What are your specific areas of surgical expertise?
- Volumes: How many times have you performed the procedure I need in the past twelve months? For how many years have you been performing this surgery and how many times have you done this surgery overall?
- Facility volumes: How often do you perform this surgery at this healthcare facility?
- Training: Are you board certified and did you undergo fellowship training in your specialty?
- Complication and death rates: What is your complication rate for this surgery? What is the death rate?
- Contributing risk factors: Am I at an elevated risk for complications or poor outcomes due to my health or other factors?
- Available surgical options: Is there a minimally invasive option for this surgery or is open surgery required? What are the risks and benefits of each approach?
- Anesthesia: Who will be the anesthesiologist for this procedure and how experienced is he or she?
- Surgery timing: Are there any risks to waiting or trying other treatment options before having this surgery?
In addition to talking with the surgeon, working with a health advisor can help you gather information on physicians and treatment options, as well as provide help arranging in-person or virtual second opinions with expert physicians.
Proactive steps you can take to lower your risk of surgical complications
While the experience and expertise of your surgeon and the surgical team and hospital play a significant role in your outcome, there are also proactive strategies you can employ to lower your risk of complications and other post-surgery problems:
- If you smoke, quit. Smoking can increase your risk of complications and slow healing by constricting blood vessels, decreasing the delivery of oxygen and nutrients to tissues that are healing. The vessel constriction also increases inflammation in the body and can increase the risk of the development of blood clots. Smoking also weakens the immune system.
- Choose a healthy diet. Good nutrition before surgery promotes healing. Make sure you eat an adequate amount of protein to build or preserve muscle mass. Staying well hydrated is also important. Drinking enough water supports optimal circulation. Avoiding ultra processed foods, sugar-based drinks, and alcohol can also help decrease inflammation and dehydration.
- Consider prehabilitation. Talk with your surgeon or primary care physician to find out if a pre-surgery physical conditioning program is appropriate for you. Studies have found that taking part in regular moderate to vigorous exercise is associated with a lower risk of complications after surgery.
- Manage chronic conditions. If you are living with diabetes, high blood pressure, high cholesterol, asthma, COPD, or any other chronic condition, work with your primary care physician and specialists to achieve the best possible control of your condition before surgery.
Connect with PinnacleCare
For more information about how PinnacleCare can help you choose an experienced surgeon or take advantage of second opinions to better your health outcomes, connect with us today.
FAQs for Maximizing Surgical Outcomes: Surgeon Experience and Proactive Patient Choices
PinnacleCare is a member of the Sun Life Financial Inc. (“Sun Life”) family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of your medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.
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