What size population in a catchment area is required for a Thoracic (thoracic) surgeon to maintain high volume?

From the Guidelines

A thoracic surgeon typically needs to perform at least 40-50 major thoracic procedures annually to maintain high-volume status, which can be achieved with a catchment area population of approximately 500,000 to 1 million people. High-volume thoracic surgeons generally require a sufficient case volume to maintain surgical expertise and optimal outcomes, with some definitions requiring higher thresholds of 75-100 cases per year 1. The exact population needed may vary depending on disease prevalence, referral patterns, competition from other surgeons, and the specific procedures performed.

Key Considerations

• Rural areas may require larger catchment populations due to lower population density, while urban centers with higher disease prevalence or specialized centers that attract referrals may need smaller catchment areas.
• Maintaining high-volume status is important because numerous studies have demonstrated that thoracic surgeons who perform more procedures typically achieve better outcomes, including lower mortality rates, fewer complications, and shorter hospital stays for their patients 1.
• The thresholds used to define surgical procedure volumes vary from one study to another, with proposed thresholds ranging from 20 to 90 cases per year 1.

Volume Thresholds

• A threshold of more than 190 pulmonary resections per year has been proposed by some studies 1.
• Other studies have proposed thresholds of between 40 and 70 pulmonary resections per year 1.
• The European Respiratory Society and European Society of Thoracic Surgeons guidelines advise that lung resections be performed in centers with a minimal surgical volume of 20 to 25 major anatomic resections per year 1.

From the Research

Population Requirements for High-Volume Thoracic Surgeons

To determine the population requirements for high-volume thoracic surgeons, we need to consider the number of surgeries performed and the caseload per surgeon.

• The average number of operations performed by thoracic surgeons per year is around 135 2, 3.
• By 2035, the average caseload per surgeon is expected to increase to 299 cases, representing a 121% increase for the individual surgeon 3.
• The total number of cases for cardiothoracic surgeons is projected to increase from 530,000 in 2010 to 853,912 in 2035, a 61% increase 3.

Surgeon Specialty and Volume

The influence of surgeon specialty on outcomes in general thoracic surgery is significant.

• General thoracic surgeons and cardiac surgeons achieve better outcomes than general surgeons 4.
• Differences in mortality may be more dependent on surgeon volume than subspecialty, while differences in morbidity are significantly impacted by surgeon specialty and volume 4.

Workforce Needs

The cardiovascular workforce needed by 2030 to meet the needs of the population is estimated to be around 5169 cardiothoracic surgeons 5.

• However, there will be a shortage of approximately 2000 cardiothoracic surgeons, with only around 3200 in practice 5.
• To maintain the current status per 100,000 population from 2011 to 2030, around 4000 residents need to be trained, at a cost of over $2 billion 5.

Catchment Area Population

While there is no direct evidence on the specific population size required for a high-volume thoracic surgeon, we can estimate the needs based on the projected caseload and workforce requirements.

• A high-volume thoracic surgeon would likely require a catchment area with a large population to support the expected caseload of around 299 cases per year 3.
• The exact population size would depend on various factors, including the prevalence of thoracic diseases, the number of surgeons in the area, and the referral patterns.