Elective surgery growth at Florida hospitals accrues mostly from surgeons averaging 2 or fewer cases per week: A retrospective cohort study

Abstract

Study objective: Hospital administrators often seek to increase operating room (OR) elective caseload. Previous studies from Iowa demonstrated that surgical growth is mostly from low-caseload surgeons (ie, ≤2 cases per week). We repeated that study using data from Florida, a much more populous state, to confirm the generalizability of the findings. Design: Retrospective cohort study. Setting: All hospitals in the state of Florida. Patients: All patients undergoing elective surgery during 2018 and 2019. Measurements: We determined growth between 2018 and 2019 in regular-workday elective surgical caseload and intraoperative work relative value units (wRVU) at hospitals. Using the two-sided, one group Student t-test, we compared the fractions of those increases attributable to low-caseload surgeons vs. 50% to assess if they accounted for most surgical growth. We used the exact binomial test to compare the fraction of hospitals where most growth (>50%) occurred from low-caseload surgeons to half (50%). Main results: We studied the 1,629,879 elective cases from 202 hospitals. Surgeons averaging ≤2.0 cases per week accounted for 73.3% (P < 0.0001 compared to 50%) of caseload growth and 68.7% (P < 0.0001 compared to 50%) of wRVU growth. The corresponding overall pooled growth estimates among hospitals were 70.8% for caseload and 65.0% for wRVU. There were 76.2% of the N = 202 hospitals with more than half their growth in cases from surgeons performing, on average, ≤2.0 cases per week (P < 0.0001 compared to 50% of hospitals). The vast majority of surgical growth at hospitals accrued from the contributions of low-caseload surgeons. Conclusions: Surgical growth in elective surgery at Florida hospitals accrued mostly from the increased activity of low-caseload surgeons averaging ≤2.0 cases per week during the preceding year, confirming the generalizability of the previous Iowa study. If growth in caseload is desired, surgical governance committees should ensure that low-caseload surgeons have access to the OR schedule.