A recent report on the results of colon (large intestine) surgery revealed that high and low (caseload) volume surgeons -- those that are very busy versus those who do a few cases a year -- are quite similar. This fact has been shown in other reports. By comparison, there is a definite relationship between high case volume and better outcomes (fewer complications and fewer deaths) when the surgeon is performing very complex operations. These include surgery of the esophagus (gullet), abdominal aorta for aneuysm, and thoracic cases (chest). Colon surgery is an operation of intermediate complexity.

If you're anticipating undergoing a standard operation in a small community hospital, you don't need to worry that you're missing out on the expertise of an academic medical center surgeon. Chances are that the private practice surgeon has done tons more of the operation you need such, as groin hernia or gallbladder removal, and has better outcomes than the research-oriented surgeon for some operations. In fact, the really skilled community hospital surgeons often have excellent results with more complex operations as well. Surgery is a performing art and guidelines as to who is best are fraught with misinterpretation.

The problem is that you don't know who's who. Nor do I. But you can ask about your surgeon's experience and results. And if your surgeon balks at or seems offended by these queries, then you already know that you're in the wrong office.

Ask:

1. How many of these operations have you done? How many this year? ("Just a couple..."  doesn't cut it)

2. How have your patients done after surgery? What complications have you had? ("They've done pretty well..." doesn't cut it)

Insist on more specific answers.

Remember the report I alluded to at the beginning? It stated that the vast majority of the deaths in their colon surgery series occurred because the patients were so sick that leaks where the intestines were joined together (called an anastomosis) was part of the act of dying, not the cause of death. So interpreting outcomes has its risks as well.

More on dealing with surgeons in the future.