Objective: To examine the association between hospital operation volume and surgeon operation volume and the risk of surgical site infection (SSI).
Design: Prospective, multicenter cohort study based on surveillance data.
Methods: Data were obtained from the Dutch surveillance network for nosocomial infections (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]) on 9 different types of orthopedic surgery, general surgery, and gynecology procedures performed during 1996-2003. Multilevel logistic regression analysis was performed to assess the independent effect of hospital volume and surgeon volume on SSI risk.
Results: Hospital volume was not significantly associated with SSI risk for any of the selected procedures. Low surgeon volume was associated with an increased risk for an infection for 7 of 9 types of procedures, although this effect was statistically significant only for knee arthroplasty. For 4 procedures, the odds of exceeding the 75th percentile for duration of surgery were greater when the surgeon volume was low than when the surgeon volume was moderate or high.
Conclusions: Patients operated on by surgeons with a low operation volume seem to have a higher risk of developing an SSI with some procedures, particularly knee arthroplasty. The higher SSI risk for surgeons with a low operation volume is possibly partly mediated by the longer duration of surgery, a well-known risk factor for development of SSI.