Distribution of case volumes in surgery: an analysis of the British Spine Registry

Chan Hee Koh; William Muirhead; Danyal Zaman Khan; Hugo Layard Horsfall; George Prezerakos; Parag Sayal; Hani J Marcus

doi:10.1136/bmjsit-2023-000202

Distribution of case volumes in surgery: an analysis of the British Spine Registry

BMJ Surg Interv Health Technol. 2024 Mar 22;6(1):e000202. doi: 10.1136/bmjsit-2023-000202. eCollection 2024.

Authors

Chan Hee Koh^{1

2

3

4}, William Muirhead^{1

2}, Danyal Zaman Khan^{1

2

4}, Hugo Layard Horsfall^{1

2}, George Prezerakos^{1

3

4}, Parag Sayal¹, Hani J Marcus^{1

2

4}

Affiliations

¹ Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
² Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
³ Neurosciences Institute, Cleveland Clinic London, London, UK.
⁴ UCL Queen Square Institute of Neurology, London, UK.

Abstract

Objectives: To characterize the distribution of case volumes within a surgical field.

Design: An analysis of British Spine Registry.

Setting: 295 centers in England that conducted at least one spinal operation either within the NHS or private settings between 1 May 2016 and 27 February 2021.

Participants: 644 surgeons.

Main outcome measures: Mathematical descriptions of distributions of cases among surgeons and the extent of workforce-level case-volume concentration as a surrogate marker.

Results: There were wide variations in monthly caseloads between surgeons, ranging from 0 to average monthly high of 81.8 cases. The curves showed that 37.7% of surgeons were required to perform 80% of all spinal operations, which is substantially less than in fields outside of healthcare.With the COVID-19 pandemic, the case volumes of surgeons with the highest volumes dropped dramatically, whereas those with the lowest case numbers remained nearly unchanged. This, along with the relatively low level of case-volume concentration within spinal surgery, may indicate an inevitability of at least some level of surgical care being provided by the relatively lower volume surgeons.

Conclusions: While there is a reasonable degree of workforce-level case volume concentration within spinal surgery, with high volume spinal surgeons providing a large proportion of care, it is not clear whether a further concentration of case volumes into those few hands is possible or desirable.

Keywords: Health Care Quality, Access, and Evaluation; Health Policy; Health Services Research; Learning Curve.