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Effect of Surgeon Training, Specialization, and Experience on Outcomes for Cancer Surgery: A Systematic Review of the Literature

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Outcomes after cancer resections have been shown to be better for high-volume surgeons compared with low-volume surgeons; however, reasons for this relationship have been difficult to identify. The objective of this study was to assess studies examining the effect of surgeon training and experience on outcomes in surgical oncology.

Methods

A systematic review of the literature was performed to assess articles examining the impact of surgeon training, certification, and experience on outcomes. Studies were included if they examined cancer resections and performed multivariable analyses adjusting for relevant confounding variables.

Results

An extensive literature search identified 29 studies: 27 examined surgeon training/specialization, 1 assessed surgeon certification, and 4 evaluated surgeon experience. Of the 27 studies examining training/specialization, 25 found that specialized surgeons had better outcomes than nonspecialized surgeons. One study found that American Board of Surgery (ABS)-certified surgeons had better outcomes than noncertified surgeons. Of the two studies examining time since ABS certification, both found that increasing time was associated with better outcomes. Of the four studies that examined experience, three studies found that increasing surgeon experience was associated with improved outcomes.

Conclusions

Although numerous studies have examined the impact of surgeon factors on outcomes, only a few cancers have been examined, and outcome measures are inconsistent. Most studies do not appear robust enough to support major policy decisions. There is a need for better data sources and consistent analyses which assess the impact of surgeon factors on a broad range of cancers and help to uncover the underlying reasons for the volume–outcome association.

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Acknowledgment

Supported in part by a VA Career Development Award (DJB) and by a grant from the Illinois Division of the American Cancer Society (DJB).

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Authors and Affiliations

  1. Northwestern Memorial Hospital, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karl Y. Bilimoria MD, MS, Joseph D. Phillips MD, Colin E. Rock BA, Amanda Hayman MD, MPH, Jay B. Prystowsky MD, MHPE & David J. Bentrem MD, MS

  2. Jesse Brown VA Medical Center, Chicago, IL, USA

    Jay B. Prystowsky MD, MHPE & David J. Bentrem MD, MS

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  1. Karl Y. Bilimoria MD, MS
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  2. Joseph D. Phillips MD
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  3. Colin E. Rock BA
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  6. David J. Bentrem MD, MS
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Correspondence to Karl Y. Bilimoria MD, MS.

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Bilimoria, K.Y., Phillips, J.D., Rock, C.E. et al. Effect of Surgeon Training, Specialization, and Experience on Outcomes for Cancer Surgery: A Systematic Review of the Literature. Ann Surg Oncol 16, 1799–1808 (2009). https://doi.org/10.1245/s10434-009-0467-8

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  • DOI: https://doi.org/10.1245/s10434-009-0467-8

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