Surgeon Volume and the Outcomes of Dupuytren's Surgery: Results from a Dutch Multicenter Study.

BACKGROUND

For many major surgical procedures, the outcomes are better when performed by surgeons with higher procedure volumes. The purpose of this study was to examine the relations between surgeon procedure volume and the outcomes of Dupuytren's surgery.

METHODS

The authors conducted an observational study from 2011 to 2014 at six dedicated hand surgery practice sites in The Netherlands. Five hundred eighty-eight patients underwent surgery for Dupuytren's contracture performed by one of the 16 surgeons. The main exposure variable was annual surgeon volume. Outcome measures were the degree of residual contracture, full release rate, and any postoperative adverse event examined within 3 months of surgery.

RESULTS

Mean annual surgeon volume was 51 among the 16 surgeons(range; 4-86) procedures. The majority of patients had primary disease (79 percent) and underwent open fasciectomy (74 percent). Multivariable regression analyses showed that surgeon volume was linearly related to all three outcomes, and identified no optimal volume threshold. Performing 10 additional procedures annually was independently associated with nearly 0.8 degree less residual contracture (p = 0.002), 9 percent higher odds of attaining a full release (p = 0.037), and 11 percent lower odds of an adverse event (p < 0.001). Nonetheless, patient-related factors had larger impacts on all three clinical outcomes than surgeon volume.

CONCLUSIONS

In this study of practicing hand surgeons, surgeon volume varied widely, and a higher volume was associated with less postoperative residual contracture, higher full release rates, and fewer adverse events. This implies that increasing surgeon's procedure volume provides an opportunity for improving the outcomes of Dupuytren's surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.