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carotid artery disease treatment
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carotid artery disease treatment

how many carotid surgeries should a surgeon have performed to be skilled and experienced?


This discussion is related to Re: carotid artery blockage.
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976897_tn?1379171202
Perhaps you should really be asking how many were a success?
I would be happy if they had successfully done one or two, the knowledge is there then.
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From http://www.medlit.info/member/malpracticenews/vol10iss1/surgical_skill.htm

This site is saying that, for carotid endarterectomy, you should look for a surgeon who does at least 100 of them per year.  In other words, carotid endarterectomy is considered to be a procedure that a surgeon has to do lot of, and keep doing a lot of, to get good at it and stay good at it.

"For certain relatively common but complex surgical procedures, a minimum number of procedures annually is required to significantly reduce complication rates.  Operations for which better outcome has been demonstrated for high-volume surgeons include ... carotid endarterectomy ...  The Leapfrog group have established evidence-based minimum thresholds for certain surgical and invasive procedures - ... carotid endarterectomy (100/year). "



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I wouldn't take much notice of the leapfrog group, this is a company based on improving services provided in health to its employees and is run by non medical experts such as toyota and power companies.
In the UK, if a surgeon has little experience in a particular type of surgery, they are overseen by a senior surgeon, usually from a research or teaching position. You would not get one of these to operate on you unless your case was very specialised, so having a less experienced surgeon is the only other way. This is why I said one or two operations would be sufficient for me.
To keep things in perspective, carotid enderaterecomy procedures have a very high success rate, over 97% and so I fail to see why any change really needs to be made. Every single procedure is different, different vessels are affected in different people, not just the carotid arteries. The disease is at different stages in development, the disease is more severe in some and of course, not all have the other carotid artery to supply blood to the head while this one is being treated, so every case is individual.
I think personally the leapfrog group idea is prepostorous. If everyone who needed carotid surgery went to a surgeon with such a high level of experience, the system would collapse. People would be dropping like flies while hanging around in the huge waiting lists. The only solution in that case would be to create more endarterectomy experts, but who would use them? how would they gain their experience? When the existing experts retire, millions will die of carotid disease because there will be nobody to perform the surgery.
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367994_tn?1304957193
QUOTE: "This site is saying that, for carotid endarterectomy, you should look for a surgeon who does at least 100 of them per year.  In other words, carotid endarterectomy is considered to be a procedure that a surgeon has to do lot of, and keep doing a lot of, to get good at it and stay good at it".

One hundred a year is not very much volume for endarterectomy when compared to about 500 a year for heart surgeons.  It has been my response regarding heart surgeons' qualifications, and based on my research my answer is at least 1000 without contributing fault.  That would be two years experience, and the Mayo Clinic has doctors' with those credentials..

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367994_tn?1304957193
QUOTE:"I think personally the leapfrog group idea is prepostorous. If everyone who needed carotid surgery went to a surgeon with such a high level of experience, the system would collapse. People would be dropping like flies while hanging around in the huge waiting lists. The only solution in that case would be to create more endarterectomy experts, but who would use them? how would they gain their experience? When the existing experts retire, millions will die of carotid disease because there will be nobody to perform the surgery."

I fail to see the logic in the above response at least in a non-socialist point of view.  The Leapfrog's mission is identical to published consumer reports that evaluate on the market products based on independant surveys regarding price, durability, etc..  The consumer can decide based on the available information   Consumer reporting is a successful enterprise and consumer helpful.  Government doesn't decide what one can purchase, however, it seems the nose-of-the camel is under the tent.

The Leapfrog Hospital Survey is the gold standard for comparing hospitals’ performance on the national standards of safety, quality, and efficiency that are most relevant to consumers and purchasers of care. Hospitals that participate in The Leapfrog Hospital Survey achieve hospital-wide improvements that translate into millions of lives and dollars saved.

"In 1998 a group of large employers came together to discuss how they could work together to use the way they purchased health care to have an influence on its quality and affordability. They recognized that there was a dysfunction in the health care market place. Employers were spending billions of dollars on health care for their employees with no way of assessing its quality or comparing health care providers".

In a free enterprise environment the demand and supply governs the price, number of practioners in a specific line of work, etc.  When the governnment interfers with free choice there is unfair advantage to one group vs another.  As an example the government does not allow the purchase of medication from any source outside the state approved source.  The state approved source has a monopoly.  If an individual has medication sources outside the specific state,  the competetion for medication would cause prices to drop.

If there is a shortage of doctors that do endarterectomy, the price of the operation would rise and more doctors would go into that field, less demand fewer doctors etc. etc.  Unforunately there is too much government interference, and the government is making decisons that should be made by a doctor and the patient.  When the government gets involved the system becomes inefficient and medical care wanes.  Socialized medication results with problems that you have cited...long lines, fewer specialised doctors (government decides, not free market).    
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In the UK, the health service was run by the Doctors. However this failed. It failed dismally because the Doctors didn't have enough time to run a health system as well as take care of patients. Waiting lists grew into years. It was very common to be in a waiting list for any treatment for two years or more.
The government in its infinite wisdom put managers into every hospital to ensure it ran smoothly. This is still the system in place today and it has improved a great deal. Waiting lists have reduced to just a few weeks. The only mistake the health service made in the UK was sub contracting important health care issues such as cleaning. Cheap labour to make cuts has found its way into every hospital and the job was far more efficiently done when the hospitals hired their own staff. Outbreaks of MRSA etc are the result of this, not because the bugs have become more immune to cleaning products. When I was in hospital last, I refused to get into bed because I noticed blood stains on the frame.
The other strain on our health service is salaries for nurses. When our nurses are trained, they leave the country to virtually double their income and live where the cost of living is lower. Now the policy seems to be bring in immagrants, train them up and keep them on because the standard of living in the UK is higher than their original country. It really is silly when you have trouble communicating to a nurse because their english is so bad.
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367994_tn?1304957193
QUOTE: "I think personally the leapfrog group idea is prepostorous. If everyone who needed carotid surgery went to a surgeon with such a high level of experience, the system would collapse. People would be dropping like flies while hanging around in the huge waiting lists. The only solution in that case would be to create more endarterectomy experts, but who would use them? how would they gain their experience? When the existing experts retire, millions will die of carotid disease because there will be nobody to perform the surgery".

Let me ask the question differently, what are economical principles you have considered to conclude that a consumer group's (leapfrog survey) interest to inform a consumer for medical care is prepostorous.  More directly why is the comment "The Leapfrog group have established evidence-based minimum thresholds for certain surgical and invasive procedures - ... carotid endarterectomy (100/year). " prepostorous?  Are questioning the evidence, are questioning insufficient data and data retrival methods, etc.? But that can't be the issues as you used the word prepostorous to refer to goup's objective to fully inform the consumers regarding medical care!  Is that a medical socialist's point of view?  

You reference good management by qualified business managers as a solution in a particular situation...as a consumer advocate, leapfrog group, would embrace, record and make public that information.  




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Back to pepper330's original question, I would say it is always best to go to the most skilled and experienced surgeon you can get, for any surgical procedure.  In most instances, you will be limited to choosing from a finite number of surgeons.  So if your choice is between a surgeon who has done none and a surgeon who has done one, take the surgeon who has done one.  If your choice is between a surgeon who has done one and a surgeon who has done 1000, I would take the surgeon who has done 1000.

I do agree with ed34 that, "Every single procedure is different, different vessels are affected in different people, not just the carotid arteries. The disease is at different stages in development, the disease is more severe in some and of course, not all have the other carotid artery to supply blood to the head while this one is being treated, so every case is individual."  And that is why skill goes hand in hand with experience.  Only an experienced surgeon has had an opportunity to see many different types of presentations.  

If something unexpected were to come up in your procedure, you want your surgeon to be someone who has seen the same thing before and has had an opportunity to learn from experience how to handle it.  You don't want, or at least I don't want, to be part of somebody's learning curve -- if I can help it.  I want to be the beneficiary of the learning curve.  I'm selfish like that, and I think most people are.  

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