A central question in medical training is whether higher patient volumes correlate with superior training and outcomes. Medical trainees and physicians routinely evaluate program caseloads when making career decisions.
A 2002 meta-analysis examined this relationship across 135 studies. According to the analysis, "71% of the studies on hospital volume and 69% of the studies on physician volume reported statistically significant associations between higher volume and better outcomes," particularly in AIDS treatment, pancreatic cancer surgery, esophageal cancer surgery, abdominal aortic aneurysm repair, and pediatric cardiac issues. Of 21 studies examining both hospital and physician volume effects, 4 identified physician volume effects alone, while 12 found effects for both variables.
Research specifically examining anesthesiologist experience yielded notable findings. One retrospective study of nearly 9,000 surgical patients found that "7.6% of patients that received anesthesia from experienced pairs had complications compared to 12% with inexperienced pairs." Experienced teams demonstrated fewer bleeding complications, infections, shorter hospitalizations, and reduced in-hospital mortality.
A second study involving 8,096 patients undergoing complex gastrointestinal cancer procedures (esophagectomy, pancreatectomy, hepatectomy) compared high-volume anesthesiologists (greater than 6 procedures annually) with low-volume providers (fewer than 6 annually). High-volume anesthesiologists achieved a 90-day morbidity rate of 36.3%, compared to 45.7% for low-volume providers. Additionally, high-volume anesthesiologists demonstrated lower unplanned ICU admission rates, though no differences appeared in readmission or mortality rates.
The studies acknowledge limitations, including varied methodologies, different volume thresholds for "experienced" status, and examination of different surgical types. The conclusion is that "more research is needed to replicate these results."