Related Experiment Video
Updated: Nov 3, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Surgeon experience versus volume differentially affects lower extremity bypass outcomes in contemporary practice
Salvatore T Scali1, Andrew J Martin2, Dan Neal2
1Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla; Malcolm Randall Veterans Affairs Hospital, Gainesville, FL.
Surgeon experience, not just case volume, is key for successful lower extremity bypass (LEB) surgery. More experienced surgeons achieve better in-hospital outcomes and reduce major adverse limb events, highlighting the importance of mentorship for less experienced vascular surgeons.
Area of Science:
- Vascular Surgery
- Surgical Outcomes Research
- Healthcare Quality Improvement
Background:
- Growing calls for minimum case thresholds in surgeon credentialing.
- Volume-outcome relationships primarily studied in nonvascular surgery and aneurysm repair.
- Limited data on extrapolating these findings to lower extremity bypass (LEB) outcomes.
Purpose of the Study:
- To determine whether surgeon experience or annualized case volume is more critical for successful lower extremity bypass (LEB) reconstruction.
- To analyze the impact of surgeon experience and case volume on LEB outcomes.
Main Methods:
- Analysis of 25,852 infrainguinal bypass procedures from the Society for Vascular Surgery Vascular Quality Initiative registry (2003-2019).
- Categorization of procedures by surgeon experience (years in practice) and annual LEB case volume (quartiles).
- Use of mixed-effects logistic and Cox regression models to assess the influence of experience, volume, and their interaction on outcomes.
Main Results:
- Increasing surgeon experience significantly reduced in-hospital complications and major adverse limb events.
- Both experience and volume were associated with improved freedom from thrombosis.
- Higher surgeon volume correlated with diminished long-term survival.
- Experienced surgeons (>15 years) were more likely to perform LEB for rest pain and utilize optimal surgical techniques (autogenous conduits, in situ reconstruction, pedal targets).
- Experienced and high-volume surgeons demonstrated reduced blood loss and shorter procedure times.
Conclusions:
- Surgeon experience is the most significant predictor of successful lower extremity bypass (LEB) performance, leading to better in-hospital outcomes and reduced major adverse limb events.
- Experienced surgeons perform more complex reconstructions with fewer complications.
- Findings emphasize the need for mentorship strategies to support less experienced surgeons, ensuring sustained optimal limb salvage and informing credentialing paradigms.
