From the Guidelines
A thoracic surgeon should perform at least 48 anatomic surgical resections annually, which translates to around 200-300 operations per year, considering the varying complexity and types of procedures. This recommendation is based on the American College of Chest Physicians evidence-based clinical practice guidelines, which suggest that ideally, general thoracic surgical procedures would constitute 75% of the thoracic surgeon’s clinical practice, and involve an average of 4 anatomic surgical resections performed per month at the center to maintain the experience and smooth function of the care teams 1.
The caseload of a thoracic surgeon can vary based on several factors, including:
- Practice setting (academic vs. community hospital)
- Subspecialty focus within thoracic surgery
- Geographical location
- Institutional resources Some studies have reported a favorable influence of high surgical volume on operative mortality, although the definition of high volume can range from 20 to 90 cases per year 1.
Given the variable volume thresholds used in the literature, it is essential to consider the complexity of cases and the surgeon's participation in multidisciplinary care teams when determining the ideal annual surgical volume. The recommended annual volume of 48 anatomic surgical resections or around 200-300 operations per year is generally sufficient to maintain proficiency while allowing for comprehensive pre-operative and post-operative care of patients with complex thoracic conditions.
From the Research
Annual Operations Performed by Thoracic Surgeons
- The average number of operations performed by thoracic surgeons in the United States is 135 per year, addressing diseases of the lungs, trachea, esophagus, chest wall, mediastinum, and diaphragm 2.
- Video-assisted thoracoscopic surgeries are the most commonly performed procedures, primarily completed to treat lung cancer 2.
- High-volume thoracic surgeons, defined as those who perform 20 or more annual surgical procedures, have been shown to have better outcomes in terms of conversion-to-open rate and 30-day complication rate when performing robotic-assisted lobectomies compared to video-assisted thoracoscopic surgeons 3.
- The volume of operations performed by thoracic surgeons can impact outcomes, with higher volume surgeons tend to have better results 4, 5.
Comparison of Surgical Approaches
- Robotic-assisted lobectomy has been shown to have a lower conversion-to-open rate and lower 30-day complication rate compared to video-assisted thoracoscopic surgery lobectomy 3, 5.
- Video-assisted thoracoscopic surgery lobectomy and robotic lobectomy have been shown to have reduced 30-day mortality, pulmonary complications, and overall complications compared to open lobectomy 6, 5.
- The choice of surgical approach may depend on various factors, including the surgeon's expertise and the patient's specific condition 3, 6, 5.