Prevention

Surgical complications are more likely with low annual operating volumes for surgeons and hospitals ^b and the surgeon's place of training. ^b

Why?

Surgeons performing few operation in hospitals with few operations are associated with increased mortality

b	mortality rate (95% CI)
surgeon performing < 5 operation per year in a hospital with ≤ 100 procedures a year	2.0%  (1.5% to 2.6%)
surgeon performing ≥ 5 operation per year in a hospital with > 100 procedures a year	0.94%  (0.73% to 1.2%)

Surgical training affects operative complication rate

Patient b	Prognostic Factor	Outcome	CER	RR (95% CI)	NNF+ (95% CI)
undergoing carotid endarterectomy	surgeons not trained in North America or Western Europe working in the USA independent	death, stroke, myocardial infarction at 30 days	11%	1.91 (1.12 to 3.13)	10 (4 to 76)