Too Much of a Good Thing or Operating at the Fringe: Comment on “National Register Study of Operating Time and Outcome in Hernia Repair”

The relationship between surgical volume and performance continues to be a subject of considerable interest to surgeons, patients, and payors. In general, studies to date have made the intuitive observation that with increasing procedure frequency and/or surgeon experience, there is a proportional—and sometimes logarithmic—decline in operative time, operative time variability, and complication rate.^1-3 These findings are relevant in their implications for the allocation of finite operative resources, as well as for approaches to surgical education and continuing professional development.