The effect of experience on the likelihood of an adverse event, while statistically significant, was small in magnitude. Increased surgeons’ experience was associated with a reduction of one adverse event in one of every five patients. Even after adjusting for the variables detailed in Tables Tables1through1through 3, all the findings above persist. The first and second Bicalutamide mw columns of Table 5 reports the analysis for lobectomies for all surgeons and then surgeries performed exclusively by thoracic surgeons. For the most part, the volume-outcome relationship for thoracic surgeons is stronger. Doubling of the thoracic surgeons experience was associated with a 13% reduction in inpatient cost ($2,409) and a 7% reduction in surgery time (18 minutes). All other results were similar to the ones obtained for all surgeons.

The second and third columns of Table 5 repeat the analysis for patients undergoing VATS wedge resection. Here, for most outcomes and specifications, the volume-outcome relationship appears much weaker. Doubling of the surgeon’s experience was associated with a 3% reduction in inpatient cost ($389), a 2% reduction in surgery time (3 minutes), and an 8% reduction in hospital length of stay (a third of a day). The results were similar when considering the most saturated model and when limiting the sample to procedures performed solely by thoracic surgeons. The only exception was the reduction in cost for the thoracic surgeon sample, which was 5% ($659).

Table 6 reports results from models similar to those reported in Table 5, and includes two additional variables: the surgeon’s six-months experience with open lobectomies and the surgeon’s six-months experience with open wedge resections. The two additional volume measures allow for assessing the contribution of competing sources of learning. For example, for the VATS lobectomy sample, one may argue that any experience with lobectomy (open or VATS) may be an important contributor for performance. This is tested directly in Table 6. Overall we find the volume-outcome relationship for experience with VATS to be similar in sign, magnitude, and statistical significance to those described in Table 5. Experience with open lobectomy did not have an effect on outcomes for patients treated with VATS lobectomy, with the exception of the number of adverse events, where greater experience with open lobectomy was associated with a small reduction in the number of adverse events for VATS lobectomy. Similarly, experience with open wedge resection was associated with a reduction in inpatient cost and length of stay beyond the reductions associated Anacetrapib with greater experience with VATS. Table 6 Multivariable results for cost, utilization, and adverse events (including non-VATS volume). 4.