• Richard H Epstein, Franklin Dexter, Christian Diez, and Brenda G Fahy.
• Department of Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1611 NW 12th Avenue, Central Building, Suite C300, Miami, FL 33136, United States. Electronic address: repstein@med.miami.edu.
• J Clin Anesth. 2022 Jun 1; 78: 110649.

Study ObjectiveHospital administrators often seek to increase operating room (OR) elective caseload. Previous studies from Iowa demonstrated that surgical growth is mostly from low-caseload surgeons (ie, ≤2 cases per week). We repeated that study using data from Florida, a much more populous state, to confirm the generalizability of the findings.DesignRetrospective cohort study.SettingAll hospitals in the state of Florida.PatientsAll patients undergoing elective surgery during 2018 and 2019.MeasurementsWe determined growth between 2018 and 2019 in regular-workday elective surgical caseload and intraoperative work relative value units (wRVU) at hospitals. Using the two-sided, one group Student t-test, we compared the fractions of those increases attributable to low-caseload surgeons vs. 50% to assess if they accounted for most surgical growth. We used the exact binomial test to compare the fraction of hospitals where most growth (>50%) occurred from low-caseload surgeons to half (50%).Main ResultsWe studied the 1,629,879 elective cases from 202 hospitals. Surgeons averaging ≤2.0 cases per week accounted for 73.3% (P < 0.0001 compared to 50%) of caseload growth and 68.7% (P < 0.0001 compared to 50%) of wRVU growth. The corresponding overall pooled growth estimates among hospitals were 70.8% for caseload and 65.0% for wRVU. There were 76.2% of the N = 202 hospitals with more than half their growth in cases from surgeons performing, on average, ≤2.0 cases per week (P < 0.0001 compared to 50% of hospitals). The vast majority of surgical growth at hospitals accrued from the contributions of low-caseload surgeons.ConclusionsSurgical growth in elective surgery at Florida hospitals accrued mostly from the increased activity of low-caseload surgeons averaging ≤2.0 cases per week during the preceding year, confirming the generalizability of the previous Iowa study. If growth in caseload is desired, surgical governance committees should ensure that low-caseload surgeons have access to the OR schedule.Copyright © 2022 Elsevier Inc. All rights reserved.

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