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Comment & Response
September 29, 2021

Looking Over the Drape—Anesthesiologists’ Volume and Surgical Outcomes

Author Affiliations
  • 1Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
  • 2Division of Cardiothoracic Surgery, University of Alabama, Birmingham
  • 3Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
JAMA Surg. 2022;157(1):78-79. doi:10.1001/jamasurg.2021.3755

To the Editor We read with strong interest the Original Investigation by Hallet et al1 on the association between anesthesiologists’ volume and surgical outcomes in patients undergoing gastrointestinal cancer surgery. The authors must be congratulated for the advanced methodology by which they have ascertained that care by high-volume anesthesiologists was independently associated with lower odds of major morbidity, unplanned intensive care unit admission, and the composite of 90-day major morbidity and readmission in patients undergoing esophagectomy, pancreatectomy, or hepatectomy for oncologic indications. The quality of results was boosted by integrating information from multiple data sets whose data cleaning and validity had been previously proven by formal studies.2 We found particularly thought provoking that an anesthesiologist to surgeon ratio of 4.5 existed for these high-complexity cases (842 anesthesiologists:186 surgeons), especially taking into account that the 75th percentile of the anesthesiologists’ volume corresponded with only 6 cases per year. This becomes even more compelling when compared with the threshold used in defining high-volume surgeons in analogous, surgically oriented studies (12 esophagectomies per year and 11 pancreatectomies per year, for instance3). Additionally, while the association between surgical volume and outcomes has been extensively debated in the literature, it has also been speculated that hospital type may influence outcomes. Indeed, institutions with surgical training programs have been associated with lower short-term mortality rates in esophageal4 and hepatopancreatobiliary5 surgery.

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