Abstract
ObjectivesTo characterize the distribution of case volumes within a surgical field.DesignAn analysis of British Spine Registry.Setting295 centers in England that conducted at least one spinal operation either within the NHS or private settings between 1 May 2016 and 27 February 2021.Participants644 surgeons.Main outcome measuresMathematical descriptions of distributions of cases among surgeons and the extent of workforce-level case-volume concentration as a surrogate marker.ResultsThere were wide variations in monthly caseloads between surgeons, ranging from 0 to average monthly high of 81.8 cases. The curves showed that 37.7% of surgeons were required to perform 80% of all spinal operations, which is substantially less than in fields outside of healthcare.With the COVID-19 pandemic, the case volumes of surgeons with the highest volumes dropped dramatically, whereas those with the lowest case numbers remained nearly unchanged. This, along with the relatively low level of case-volume concentration within spinal surgery, may indicate an inevitability of at least some level of surgical care being provided by the relatively lower volume surgeons.ConclusionsWhile there is a reasonable degree of workforce-level case volume concentration within spinal surgery, with high volume spinal surgeons providing a large proportion of care, it is not clear whether a further concentration of case volumes into those few hands is possible or desirable.
Funder
NIHR Biomedical Research Centre
Wellcome EPSRC Centre for Interventional and Surgical Sciences
Cancer Research UK
NIHR Academic Clinical Fellowship
Cleveland Clinic London Doctoral Fellowship