Minimum Procedural Volume Thresholds for Surgical Privileging: A Mixed-Methods Validation and Risk Management Framework in a Multi-Specialty Healthcare Network.

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.