Surgeon volume and the outcomes of Dupuytren’s surgery: Results from a Dutch multicenter study

Objective: For a number of major complex surgical procedures, the outcomes are better when performed by surgeons with higher procedure volumes. The purpose of this study was to examine the relations between surgeon procedure volume and the outcomes of Dupuytren's surgery. Design: Observational study from 2011-14 Setting: Consortium of 6 dedicated hand surgery practice sites in The Netherlands Participants: 588 patients who underwent surgery for Dupuytren's contracture by one of the 16 surgeons from the participating sites. Exposure: Annual surgeon volume Main outcome measures: The degree of residual contracture, full release rate and any postoperative adverse event examined within 3 months of surgery. Results: Mean annual surgeon volume was 51 among the 16 surgeons, and ranged from 4 to 86 procedures. The majority of patients had primary Dupuytren's contracture (79%) and underwent open fasciectomy (74%). Multivariable regression analyses showed that surgeon volume was linearly related to all three outcomes, and identified no optimal volume threshold. Performing 10 additional procedures per year was independently associated with nearly 0.8 degree less residual contracture (p=0.002), 9% higher odds of attaining a full release (p=0.037), and 11% lower odds of experiencing an adverse event (p