Is Experience a Surrogate for Expertise?
Robert Collier, a famous American self-help author, once said, “success is the sum of small efforts, repeated day-in and day-out.”1 Thus, based on a growing number of medical studies, the mantra of “Do More, Be Greater” has been increasingly promoted and marketed by hospital administrators and health system leaders. The data are compelling correlating low-volume hospitals and low-volume surgeons with poor outcomes.2,3 However, there are few studies investigating anesthesiologists’ case volume and outcomes. In this issue of Anesthesia & Analgesia, Jaeger et al4 adopted these methodologies to retrospectively evaluate a large cancer registry database in Ontario, Canada, of radical cystectomy case volumes for anesthesiologists and associated outcomes. Using multivariable analysis while accounting for surgeon and hospital volume, the anesthesiologists who had the lowest volume of these patients (<6.5 cases/year) were associated with a significantly higher hospital readmission rate at 30 days (odds ratio [95% confidence interval] 1.36 [1.1–1.7]) and 90 days (odds ratio 1.36 [1.1–1.7]) when compared with the outcomes of anesthesiologists with the highest volumes (>11.8 cases/year).4 Notably, postoperative mortality and long-term survival were not associated with anesthesiologist volume.