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The lowest volume of surgeons and hospitals served as the reference group.
The annual arthroplasty volume of surgeons clearly has an effect on outcomes, and therefore may also affect our results.
Since the utilization of ultrasound or CT scans may be influenced by the volume of surgeons (supply) working in the region, we used the Canadian National Physician Database (NPDB) to measure the availability of surgeons.
The most important missing confounding factors are surgery in more complicated cases, high BMI, alcohol abuse and smoking, number of other institutional care facilities in the hospital district, the distance between other care facilities and the hospital, the annual arthroplasty volume of surgeons, and the socioeconomic status of patients.
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The endocrine case volume of nonspecialist surgeons remained stable over the study period.
The operative volume of individual surgeons is not known and may bias the results.
Some surgical factors such as volume, grade of surgeon, and approach have been included in analyses, but analysis of the effects of data clustering (in terms of surgeon and unit) was not possible.
Regression analysis accounted for multiple aspects of care, including hospital volume, surgeon volume, surgeon specialty designation, hospital resources, patient characteristics, and tumor stage.
When performing procedures that have failed to prove efficacy, the volume of the operating surgeons means less.
During this period of rapid growth within the ESU, the endocrine case volume of non-specialist surgeons within the institution remained stable, moving in parallel with overall surgical volumes (Fig. 1).
Shetty's Narayana Hrudayalaya chain of hospitals in India function as an 'assembly line', completing a large volume of surgeries with surgeons and other health workers focusing on a discrete task repeated on each patient (32).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com