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Patient Safety and Quality Improvement

(253) Impact of surgical experience on revision sinus surgery rate

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Chun-Kang Liao, MD

    Dr.
    Department of Otolaryngology, National Taiwan University Hospital Yunlin branch, Yunlin, Taiwan
    Taipei, Yunlin, Taiwan (Republic of China)

    • Co-Author(s)

  • CL

    Chia-Hsuan Lee, MD

    Dr.
    Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, United States

  • Wei-Chung Hsu, MD, PhD

    Pr.
    Department of Otolaryngology, National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan
    Taipei, Taipei, Taiwan (Republic of China)

  • KK

    Kun-Tai Kang, MD, MPH

    Dr.
    Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
    New Taipei City, TWN

    • Senior Author(s)

  • TY

    Te-Huei Yeh, MD

    Pr.
    Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, United States

Disclosure(s):
Chun-Kang Liao, MD: No relevant relationships to disclose.


Introduction: The implications of cumulative surgical experience on endoscopic sinus surgery (ESS) revision rates remain unclear. This study aims to elucidate the correlation between a surgeon's cumulative surgical volume and the rates of ESS revisions in Taiwan.

Methods: A nationwide population-based retrospective study was conducted, collating data from adult inpatients (age >18 years) who underwent ESS between the years 2000 and 2008. This data was acquired from the Taiwan National Health Insurance Research Database(NHIRD), with patients being followed up until 2018. Cumulative surgical volume was divided into four quartiles: very low volume (Quartile 1, cumulative volume: 1-137 cases), low volume (Quartile 2, cumulative volume: 138-328 cases), high volume (Quartile 3, cumulative volume: 329-643 cases), and very high volume (Quartile 4, cumulative volume >644 cases).

Results: The study included 68,282 adults (mean age, 45.6 years; 62% men). The initial revision rate stood at 14.6% (9951/68282), and the secondary revision rate at 2.9% (1989 /68282). There was a significant association between lower surgical volume and an increased first revision rate (very low volume: 14.9%; low volume: 15%; high volume: 14.3%; very high volume: 14.0%, p for trend = 0.006). However, there was no significant correlation with the second revision rate (p for trend = 0.11). A subgroup analysis highlighted the effect of cumulative surgical volume on revision ESS as being more pronounced in hospitals with low surgical volume as compared to high surgical volume hospitals (p for interaction = 0.049). Restricted cubic spline modeling revealed a linear, inverse correlation between cumulative surgical volume and revision ESS (p for linearity < 0.001).

Conclusions: The data suggests that lower cumulative surgical volume is associated with a higher propensity for a first ESS revision in adult patients. The correlation between low cumulative surgical volume and increased revision ESS is particularly noticeable in lower volume hospitals.