ArticleRisk management and healthcare policy2026
Minimum Procedural Volume Thresholds for Surgical Privileging: A Mixed-Methods Validation and Risk Management Framework in a Multi-Specialty Healthcare Network.
Article in Risk management and healthcare policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Purpose: To establish evidence-based annual procedural volume thresholds and surgical pairing standards for Orthopedics and Obstetrics-Gynecology (OB-GYN), and to validate these benchmarks against clinical incident rates as a proactive risk management tool. Methods: This study utilized a sequential mixed-methods design. In Phase 1, a Delphi technique was employed with 36 senior experts from the Bangkok Dusit Medical Services (BDMS) network to reach a consensus on minimum annual volumes and co-surgeon requirements. In Phase 2, a retrospective analysis of clinical incidents (Levels 4-5 and Sentinel Events) from 2022 to 2024 was performed to validate these thresholds. Statistical analysis included Mann-Whitney U and Kruskal-Wallis tests to evaluate the association between sustained compliance with these standards and clinical incident rates. Results: Expert consensus established a recommended safety threshold of 10 cases per year for high-volume procedures (eg, cesarean delivery, anterior cruciate ligament [ACL] reconstruction), with specific thresholds of 6 cases for proximal humerus fracture and 5 cases for shoulder rotator cuff repair. Quantitative validation demonstrated that surgeons meeting these thresholds had significantly lower incident rates in cesarean delivery (p < 0.001), proximal humerus fractures (p = 0.027), and shoulder rotator cuff repair (p < 0.001). Furthermore, sustained multi-year compliance over three consecutive years was strongly correlated with lower incident rates (p < 0.001). For high-complexity, low-volume procedures, the strategy shifted from numerical frequency to system-based redundancy, requiring a mandatory co-surgeon (Median Score = 5.0 on a 5-point scale). Conclusion: Maintaining a minimum annual procedural volume serves as a core proxy for surgical competency, directly reinforcing the knowledge, skill, and attitude required for patient safety. These established thresholds and team-based safety models provide a data-driven framework for institutional clinical privileging, offering hospital administrators an objective policy tool for proactive risk management.
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