Look to physicians' experience with related surgeries when credentialing for rare procedures, study suggests

New research suggests surgical experience with related procedures could help when setting volume standards for relatively rare operations, and adjusting credentials based on volume could ensure better patient outcomes, according to a new study published in JAMA Network Open

Researchers examined how outcomes for pancreaticoduodenectomies — or Whipples — a relatively uncommon and complex operation, are affected by a surgeon's volume of related procedures. Researchers analyzed Whipple case data from 2012 through 2014 from the all-payer State Inpatient Databases in New York, Florida, Maryland, Washington, Michigan and New Jersey, which included more than 1,000 surgeons and 175,000 patients. 

The study revealed that surgeons conducting a high volume of related procedures, but relatively few Whipples, had outcomes similar to their colleagues who performed more Whipples.

"This study is meant to show that we can do simple things to permit greater flexibility in surgeon-specific credentialing strategies that are intuitive and easy to measure," said Kyle Sheetz, MD, a general surgery resident at Ann Arbor-based University of Michigan.

Surgeons who performed a higher volume of related procedures had better Whipple outcomes, but only if they had conducted enough of those related procedures. The lowest volume surgeons (performing one or two Whipples annually) would have to perform 27 more related procedures each year to see their Whipple outcomes match those of surgeons conducting 12 or more Whipples per year.

The findings suggest hospitals can still provide safe patient outcomes by using flexible credentialing considerations, Dr. Sheetz said in a university news release.

"It's good for patients because in theory it expands the number of surgeons who are safe to perform their operations," Dr. Sheetz said. "For surgeons, it makes sense because it reflects their scope of practice."

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