Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
Annals of Internal MedicinePublished 17 September 2002
Ethan A. Halm, Clara Lee, Mark R. Chassin
Citations1,680
SJR quartileQ1
SJR score3.38
SNIP3.27
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
A systematic review of the research evidence linking volume and outcome in health care is conducted, to summarize and describe the methodologic rigor of the existing literature, and to highlight the research and policy implications of these findings.
Abstract
High volume is associated with better outcomes across a wide range of procedures and conditions, but the magnitude of the association varies greatly. The clinical and policy significance of these findings is complicated by the methodologic shortcomings of many studies. Differences in case mix and processes of care between high- and low-volume providers may explain part of the observed relationship between volume and outcome.
Keywords
MedicineEconomics, Econometrics and Finance
New England Journal of MedicineShould Operations Be Regionalized?
1,768 Citations1979Harold S. Luft, John P. Bunker +1 more
This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its mortality rates.
JAMAImpact of Hospital Volume on Operative Mortality for Major Cancer Surgery
1,654 Citations1998Colin B. Begg
The hypothesis that when complex surgical oncologic procedures are provided by surgical teams in hospitals with specialty expertise, mortality rates are lower is supported.
PubMedSelective referral to high-volume hospitals: estimating potentially avoidable deaths.
775 Citations2000R. Adams Dudley, Kirsten L. Johansen +3 more
Initiatives to facilitate referral of patients to HVHs have the potential to reduce overall hospital mortality in California for the conditions identified and to determine the extent to which selective referral is feasible and to examine the potential consequences.
JAMAOrganizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery
693 Citations1999Peter J. Pronovost
Organizational characteristics of ICUs are related to differences among hospitals in outcomes of abdominal aortic surgery, and Clinicians and hospital leaders should consider the potential impact of ICU organizational characteristics on outcomes of patients having high-risk operations.
Journal of Clinical OncologyHospital and Physician Volume or Specialization and Outcomes in Cancer Treatment: Importance in Quality of Cancer Care
636 Citations2000Bruce E. Hillner, Thomas J. Smith +1 more
The literature suggests that, for all forms of cancer, efforts to concentrate its initial care would be appropriate, and the absolute benefit from care at high-volume centers exceeds the benefit from break-through treatments.
Annals of SurgeryRelation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy
579 Citations1995Michael D. Lieberman, Harold Kilburn +2 more
Data from 1972 patients who had undergone pancreaticoduodenectomy or total pancreatectomy for malignancy in New York State between 1984 and 1991 support a defined minimum hospital experience for elective pancreatic resection for maligne to minimize perioperative deaths.
Annals of SurgerySurgeon-Related Factors and Outcome in Rectal Cancer
569 Citations1998Geoffrey A. Porter, Colin L. Soskolne +2 more
Outcome is improved with both colorectal surgical subspecialty training and a higher frequency ofrectal cancer surgery, and the surgical treatment of rectal cancer patients should rely exclusively on surgeons with such training or surgeons with more experience.
PubMedThe volume-outcome relationship: practice-makes-perfect or selective-referral patterns?
569 Citations1987Harold S. Luft, Sandra Hunt +1 more
Using data for 17 categories of patients from a sample of over 900 hospitals, a simultaneous-equation model is used and suggests that the relative importance of the practice or referral explanation varies by diagnosis or procedure, in ways consistent with clinical aspects of the various patient categories.
JAMAInvestigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals
541 Citations1989Edward L. Hannan
An improved measure of physician volume is used to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers.
JAMAVariation in Carotid Endarterectomy Mortality in the Medicare Population
520 Citations1998David E. Wennberg, F. Lee Lucas +3 more
Prescription patients' perioperative mortality following CEA is substantially higher than that reported in the trials, even in those institutions that participated in the randomized studies, and caution is advised in translating the efficacy of carefully controlled studies of CEA to effectiveness in everyday practice.
Annals of SurgeryImportance of Hospital Volume in the Overall Management of Pancreatic Cancer
505 Citations1998Julie Ann Sosa, Helen M. Bowman +7 more
Patients with pancreatic cancer who are to be treated with curative or palliative procedures appear to benefit from referral to a high-volume provider, and increased hospital volume is associated with markedly decreased in-hospital mortality rates and a decreased or similar length of stay for all three types of procedures and with decreases or similar hospital charges for resections and stents.
JAMAInfluence of Hospital Procedure Volume on Outcomes Following Surgery for Colon Cancer
490 Citations2000Deborah Schrag
The data suggest that hospital procedure volume predicts clinical outcomes following surgery for colon cancer, although the absolute magnitudes of these differences are modest in comparison with the variation observed for higher-risk cancer surgeries.
SurgeryEffect of hospital volume on in-hospital mortality with pancreaticoduodenectomy
483 Citations1999John D. Birkmeyer, Samuel R.G. Finlayson +4 more
Although volume-outcome relationships have been reported for many complex surgical procedures, hospital experience is particularly important with pancreaticoduodenectomy, and patients considering this procedure should be given the option of care at a high-volume referral center.
Annals of SurgeryThe Effects of Regionalization on Cost and Outcome for One General High-Risk Surgical Procedure
475 Citations1995Toby A. Gordon, Gregg P. Burleyson +2 more
An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.
New England Journal of MedicinePhysicians' Experience with the Acquired Immunodeficiency Syndrome as a Factor in Patients' Survival
462 Citations1996Mari M. Kitahata, Thomas D. Koepsell +4 more
The experience of primary care physicians in the management of AIDS is significantly associated with survival among their patients.
SurgeryThe influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer
394 Citations2002Edward L. Hannan, Mark Radzyner +3 more
For all 3 procedure groups, the risk-adjusted in-hospital mortality is significantly lower when the procedures are performed by high-volume providers.
Annals of SurgeryHospital Volume Can Serve as a Surrogate for Surgeon Volume for Achieving Excellent Outcomes in Colorectal Resection
394 Citations1999John W. Harmon, Daniel Tang +9 more
A skewed distribution of case volumes by surgeon was found in this study of patients who underwent resection for large bowel cancer in Maryland, with higher surgeon volume associated with significant improvement in all three outcomes (in-hospital death, length of stay, and cost).
SurgeryRelationship between hospital volume and late survival after pancreaticoduodenectomy
386 Citations1999John D. Birkmeyer, Andrew L. Warshaw +3 more
Hospital volume strongly influences both perioperative risk and long-term survival after pancreaticoduodenectomy, and data suggest that both patient selection and differences in quality of care may underlie better outcomes at high-volume referral centers.
The LancetInfluence of clinician workload and patterns of treatment on survival from breast cancer
380 Citations1995R Sainsbury, Raymond Haward +3 more
It is recommended that patients with breast cancer be dealt with only by clinicians who see more than 30 new cases per year and who have a full range of treatment options available within a multidisciplinary setting.
New England Journal of MedicineThe Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients
377 Citations1999David R. Thiemann, Josef Coresh +2 more
Journal of Vascular SurgeryOperative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: An eleven-year statewide experience
371 Citations1994Dolores J. Katz, James C. Stanley +1 more
The unchanged mortality rate for ruptured AAA suggests that development of better algorithms to identify those AAA most apt to rupture and earlier intervention in those instances is likely to improve patient survival rates.
PubMedCoronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors.
358 Citations1991Edward L. Hannan, Harold Kilburn +4 more
JAMACoronary Angioplasty Volume-Outcome Relationships for Hospitals and Cardiologists
342 Citations1997Edward L. Hannan
In New York State, both hospital P TCA volume and cardiologist PTCA volume are significantly inversely related to in-hospital mortality rate and same-stay CABG surgery rate for patients undergoing PTCa.
PEDIATRICSPediatric Cardiac Surgery: The Effect of Hospital and Surgeon Volume on In-hospital Mortality
338 Citations1998Edward L. Hannan, Michael Racz +3 more
Both hospital volume and surgeon volume are significantly associated with in-hospital mortality, and these differences persist for both high- complexity and low-complexity pediatric cardiac procedures.
JAMAThe Decline in Coronary Artery Bypass Graft Surgery Mortality in New York State
334 Citations1995Edward L. Hannan
The overall decline in risk-adjusted mortality could not be explained by shifts in patients away from low-Volume surgeons to high-volume surgeons, and the performance of surgeons who were not consistently low- volume surgeons was markedly better, including the markedly better performance of surgeon who were new to the system.
PubMedDoes practice make perfect? Part I: The relation between hospital volume and outcomes for selected diagnostic categories.
319 Citations1984Andrew Flood, William Russell Scott +1 more
CHEST JournalPatient and Hospital Characteristics Related to In-Hospital Mortality after Lung Cancer Resection
297 Citations1992Patrick S. Romano, David H. Mark
The overall mortality in this community-based sample exceeds that reported by selected centers and provides a better foundation for advising patients, although unmeasured severity of illness may be a confounder.
PEDIATRICSIn-Hospital Mortality for Surgical Repair of Congenital Heart Defects: Preliminary Observations of Variation by Hospital Caseload
294 Citations1995Kathy J. Jenkins, Jane W. Newburger +4 more
For children with a congenital heart defect who underwent surgery in California in 1988 or Massachusetts in 1989, the risk of dying in-hospital was much lower if the surgery was performed at an institution performing > 300 cases annually.
JAMARelation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
292 Citations2000Paul McGrath
In the era of coronary stents, Medicare patients treated by high- volume physicians and at high-volume centers experience better outcomes following PCIs, according to stratified by physician and hospital PCI volume.
New England Journal of MedicineThe Relation between the Volume of Coronary Angioplasty Procedures at Hospitals Treating Medicare Beneficiaries and Short-Term Mortality
283 Citations1994James G. Jollis, Eric D. Peterson +5 more
If the hospitals with the lowest volume had achieved the experience and technical results of the highest-volume hospitals, 381 fewer patients would have undergone CABG and there would have been 300 fewer in-hospital deaths in the population the authors studied.
Annals of Internal MedicineSelecting and Appraising Studies for a Systematic Review
282 Citations1997Maureen O. Meade, W. Scott Richardson
The subsequent steps of selecting and appraising studies for a systematic review of the effectiveness of a drug treatment and the four elements of a well-built clinical question are discussed.
Annals of SurgeryRelation of Surgical Volume to Outcome in Eight Common Operations
281 Citations1999Shukri F. Khuri, Jennifer Daley +19 more
In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk- adjusted 30- day stroke rate from CEA.
JAMAAssociation of Volume With Outcome of Coronary Artery Bypass Graft Surgery
280 Citations1987Jonathan Showstack
American Journal of Public HealthHospital volume differences and five-year survival from breast cancer.
254 Citations1998Patrick J. Roohan, Nina A. Bickell +4 more
Medical CareThe Relation Between Surgical Volume and Mortality: An Exploration of Causal Factors and Alternative Models
250 Citations1980Harold S. Luft
Multiple regression techniques are used to explore the role of other potentially important variables and alternative interpretations of the volume-mortality relationship and their relative importance varies with the procedure in ways that are consistent with anticipated referral patterns.
Journal of Gastrointestinal SurgeryA hospital's annual rate of esophagectomy influences the operative mortality rate
241 Citations1998Marco G. Patti, Carlos U. Corvera +2 more
There was a striking correlation between a hospital’s frequency of esophagectomy and the outcome of this operation, and the proposition that high-risk general surgical procedures, such as esophageal cancer surgery, should be restricted to hospitals that can exceed a yearly minimum experience is supported.
JAMAIndications, Outcomes, and Provider Volumes for Carotid Endarterectomy
228 Citations1998Randall D. Cebul
Being operated on in a higher-volume hospital conferred a 71% reduction in risk for 30-day stroke or death, and the higher rate of adverse outcomes observed in lower-volume hospitals deserves further investigation, as it does not appear to be due to differences in patient selection.
The Journal of ArthroplastyRelationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty
216 Citations1995Carlos J. Lavernia, Jose F. Guzman
Results showed that in primary arthroplasty, surgeons with a low volume of primary cases have a significantly higher mortality rate, higher average charges, and increased average length of hospital stay than in revision surgery.
CirculationRelationship Between Physician and Hospital Coronary Angioplasty Volume and Outcome in Elderly Patients
216 Citations1997James G. Jollis, Eric D. Peterson +5 more
It is suggested that adherence to minimum volume standards by physicians and hospitals will lead to better outcomes for elderly patients undergoing coronary angioplasty.
Journal of Bone and Joint SurgeryRelationship between the Volume of Total Hip Replacements Performed by Providers and the Rates of Postoperative Complications in the State of Washington*
205 Citations1997Hans J. Kreder, Richard A. Deyo +3 more
There was a significant relationship between surgeons who averaged fewer than two hip replacements annually (low-volume surgeons) and a worse outcome, and hospital charges were inversely related to hospital volume, even after adjustment for patient-related factors.
StrokeThe practice of carotid endarterectomy in a large metropolitan area.
205 Citations1984Thomas G. Brott, K Thalinger
All carotid endarterectomies performed in the greater Cincinnati metropolitan area during 1980 were reviewed and late strokes occurred without evidence for cardiac embolus or hemorrhage, consistent with a thrombogenic- embologenic operative site, and raising the question of need for adjunctive perioperative medical therapy.
StrokeRelationship Between the Volume of Craniotomies for Cerebral Aneurysm Performed at New York State Hospitals and In-Hospital Mortality
202 Citations1996Robert A. Solomon, Stephan A. Mayer +1 more
Hospitals that frequently perform aneurysm operations have lower mortality rates for patients undergoing craniotomy for cerebral aneurYSm than hospitals that perform fewer operations.
New England Journal of MedicineThe Fall and Rise of Carotid Endarterectomy in the United States and Canada
198 Citations1998Jack V. Tu, Edward L. Hannan +6 more
The absence of selective referral of patients to centers with the lowest mortality rates raises questions about whether the benefits of carotid endarterectomy in the general population are similar to those demonstrated in the clinical trials.
StrokeRelationship Between Provider Volume and Mortality for Carotid Endarterectomies in New York State
197 Citations1998Edward L. Hannan, A. John Popp +4 more
In-hospital mortality rates for carotid endarterectomies performed by surgeons with extremely low annual volumes and for hospitals with low volumes are significantly higher than the in-hospital rates of higher-volume surgeons and hospitals, even after taking preprocedural patient severity of illness into account.
PubMedHospital volume influences outcome in patients undergoing pancreatic resection for cancer.
194 Citations1996Robert E. Glasgow, Sean J. Mulvihill
This study supports the concept of regionalizing high risk procedures in general surgery, such as major pancreatic resection for cancer, by finding that high-volume providers had significantly decreased operative mortality, complication-associated mortality, patient resource use, and total charges and were more likely than low-volume centers to discharge patients to home.
Medical CareDoes Practice Make Perfect?
193 Citations1984Ann Barry Flood, W. Richard Scott +1 more
Strong and consistent evidence is found that high volume is associated with better outcomes for surgical patients, which supports regionalizing patient care by procedure and low-volume hospitals are associated with the poorest outcome for low-risk surgical patients.
Journal of the American College of SurgeonsComplex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes11No competing interests declared.
186 Citations1999Toby A. Gordon, Helen M. Bowman +8 more
It is demonstrated that increased hospital experience is associated with a marked decrease in hospital mortality and the decreased mortality at the high-volume provider was also associated with shorter lengths-of-stay and lower hospital charms.
The Journal of UrologyTHE EFFECT OF HOSPITAL VOLUME ON MORTALITY AND RESOURCE USE AFTER RADICAL PROSTATECTOMY
179 Citations2000Lars M. Ellison, John A. Heaney +1 more
Hospital volumes inversely related to in-hospital mortality, length of stay and total hospital charges after radical prostatectomy, and further study is necessary to examine the association of hospital volume with other important outcomes, including incontinence, impotence and long-term patient survival after radical Prostate cancer.
Medical CareDoes Practice Make Perfect?
173 Citations1984Ann Barry Flood, W. Richard Scott +1 more
Strong and consistent evidence that greater volume produces better outcome was found for both surgical and medical patients and is strongly supportive of the need for policies that would promote greater regionalization of a given service, and not greater size, to obtain better quality outcome for patients treated.
Journal of Vascular SurgeryInfluence of age and hospital volume on the results of carotid endarterectomy: A statewide analysis of 9918 cases
170 Citations1998Bruce A. Perler, Alan Dardik +3 more
CEA is a safe procedure in the majority of hospitals in contemporary practice, even among the very elderly, who may experience a longer length of stay and higher charges correlating with their documented greater medical complexity.
JNCI Journal of the National Cancer InstitutePopulation-Based Study of Relationships Between Hospital Volume of Prostatectomies, Patient Outcomes, and Length of Hospital Stay
169 Citations1999Siu‐Long Yao, Grace L. Lu‐Yao
It is suggested that an increase in a given hospital's prostatectomy volume may facilitate a decrease in the length of a patient's stay without an adverse impact on patient outcomes.
Journal of Vascular SurgerySurgical repair of ruptured abdominal aortic aneurysms in the state of Maryland: Factors influencing outcome among 527 recent cases
166 Citations1998Alan Dardik, Gregg P. Burleyson +5 more
Although operative rAAA repair continues to be associated with substantial risk and remains an especially lethal condition among the elderly, the operative mortality rate has declined in recent years in Maryland.
JAMARegionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes
166 Citations1995K. Grumbach
StrokeEpidemiology of Carotid Endarterectomy Among Medicare Beneficiaries
166 Citations1998David C. Hsia, Linda M. Moscoe +1 more
The frequency and rate of carotid endarterectomy showed prompt response to reports from clinical trials and perioperative mortality both improved and converged over time but did not attain the rates reported by the trials.
PubMedA longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.
163 Citations1992Edward L. Hannan, Harold Kilburn +5 more
A significant inverse relationship between hospital volume and mortality rate for unruptured aneurysms is demonstrated and very few surgeons substantially increased their aneurYSm surgery volumes in the six-year study period.
JAMARegionalization of Cardiac Surgery in the United States and Canada
161 Citations1995Kevin Grumbach
Journal of Vascular SurgeryAbdominal aortic aneurysm repair in Veterans Affairs medical centers
160 Citations1996Andris Kazmers, Lloyd A. Jacobs +3 more
Mortality rates after abdominal aortic aneurysm (AAA) repair in VA hospitals were comparable with those previously reported in other large series and may improve by referring patients eligible for elective repair to VA medical centers with a greater operative volume or to lower-volume centers that have had excellent results.
Annals of Internal MedicineLocating and Appraising Systematic Reviews
160 Citations1997Dereck L. Hunt, K. Ann McKibbon
Bibliographic databases, such as MEDLINE, Best Evidence, and the Cochrane Library are probably the most up-to-date and readily available sources of systematic reviews.
PubMedRelation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system.
157 Citations1999Marko Šimunović, Teresa To +2 more
This study adds to growing evidence that, for pancreatic resection for neoplasm, patients may have better outcomes if they are treated in high-volume hospitals rather than low- volume hospitals.
NeurologySurgeon characteristics associated with mortality and morbidity following carotid endarterectomy
148 Citations2000Liam O’Neill, Douglas J. Lanska +1 more
Surgeons who performed 1 to 2 CEAs over 2 years had the highest mortality and total bad outcome rates, and for surgeons performing three or more cases in 2 years, increased volume was not associated with better outcomes.
The Journal of ArthroplastyRelationship between mortality rates and hospital patient volume for medicare patients undergoing major orthopaedic surgery of the hip, knee, spine, and femur
146 Citations1997Harold Taylor, Douglas A. Dennis +1 more
The relationship between mortality rates and hospital patient volume for major orthopaedic surgery and diagnosis-related groups (DRGs) 209, 210, and 214 was examined, covering hip and knee arthroplasty, other hip and femur procedures, and spine procedures.
JAMAThe Relation Between Hospital Experience and In-Hospital Mortality for Patients With AIDS-Related PCP
142 Citations1989Charles L. Bennett
The findings suggest that policymakers should consider three options: creating regional AIDS centers, implementing policies that promote a rapid but carefully monitored increase in experience of low-volume hospitals with human immunodeficiency virus-infected individuals, or providing highly focused educational efforts at low-AIDS-experience facilities.
Journal of Thoracic and Cardiovascular SurgeryVolume-outcome relationships in cardiovascular operations: New York state, 1990-1995
139 Citations1999Josephine A. Sollano, Annetine C. Gelijns +8 more
The importance of these findings lies in the rather striking difference between the volume-outcome relationship found for operations for abdominal aortic aneurysms and congenital cardiac defects and the lack of such a relationship for coronary artery bypass grafting.
New England Journal of MedicineThe Relation between Volume and Outcome in Health Care
132 Citations1999Edward L. Hannan
A large number of hospitals that had higher volumes of specific surgical procedures had significantly lower inpatient mortality rates than did their lower-volume counterparts, and these hospitals were associated with higher survival rates.
Annals of SurgeryA Statewide, Population-Based, Time-Series Analysis of the Outcome of Ruptured Abdominal Aortic Aneurysm
128 Citations1996Robert Rutledge, Dale Oller +2 more
It was demonstrated that survival after RAAA was related most strongly to patient age at the time of the RAAA, which may have important implications for the regionalization of care and the education and credentialling of physicians.
Medical CareVolume-Outcome Relationships and Inhospital Mortality: The Effect of Changes in Volume Over Time
127 Citations1992Dean E. Farley, Ronald J. Ozminkowski
The results suggest that higher volume leads to better outcomes for certain groups of patients, and the effects of volume on outcome appear to be larger when estimated from longitudinal, rather than cross-sectional, data.
Journal of Vascular SurgeryHospital vascular surgery volume and procedure mortality rates in California, 1982-1994
126 Citations1998Larry M. Manheim, Min‐Woong Sohn +4 more
In-hospital mortality rates for CEA, LEAB, and unruptured AAA have been significantly decreasing over time, and Mortality is inversely related to hospital volume and directly related to patient age and emergency status.
Journal of the American College of CardiologyPatients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction
124 Citations1998Paul N. Casale, Jayne L. Jones +3 more
Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients, and patients of physicians treating a high volume of patients have approximately an 11% reduced in mortality.
American Journal of Public HealthRisk of carotid endarterectomy in the elderly.
117 Citations1989Elliot S. Fisher, David J. Malenka +4 more
Although the Medicare claims data provided only limited data about post-operative strokes, analysis of post-operatively stroke risk supported these findings.
StrokeCarotid Endarterectomy Among Medicare Beneficiaries
113 Citations1998Herbert R. Karp, W. Dana Flanders +3 more
The great majority of CEs performed in Georgia on Medicare patients were appropriate, according to current guidelines, and it is important to continue to monitor the patterns of practice for this procedure to improve outcomes.
BMJVolume and outcome in coronary artery bypass graft surgery: true association or artefact?
109 Citations1995Amanda Sowden, Jonathan J Deeks +1 more
The evidence for reduced mortality in hospitals with a high volume of coronary artery bypass graft surgery is based entirely on observational studies, which may have overestimated the benefit of increased volume because of poor adjustment for case mix.
Diseases of the Colon & RectumVariations in treatment of rectal cancer
107 Citations1997Anthony Simons, Rhonda Ker +7 more
Surgical choices in the treatment of rectal cancer may vary widely, even in a well-defined geographic region, and hospital environment and surgical caseload experience seem to have a significant role in the choice of surgical procedure and on survival.
British journal of surgeryInfluence of volume of work on the outcome of treatment for patients with colorectal cancer
103 Citations1999Jayne Parry, Sarah Collins +3 more
The influence of both hospital and surgical workload has been examined using a population‐based series of patients with colorectal cancer to highlight the importance of a ‘minimal acceptable volume of work’.
CirculationCoronary angioplasty. Statewide experience in California.
103 Citations1993James L. Ritchie, Kathryn A. Phillips +1 more
The mortality and need for CABG surgery in the statewide California PTCA experience is higher than that generally reported in the literature, and in patients with an admitting diagnosis of acute myocardial infarction, the overall mortality was higher, as was the need forCABG and the associated CabG mortality.
JAMAThe Relation Between Hospital Experience and Mortality for Patients With AIDS
103 Citations1992Valerie E. Stone
It is concluded that mortality of AIDS patients is higher at hospitals with less AIDS experience, and this finding is not because of greater severity of illness, differences in discharge patterns of the terminally ill, or less intensive use of resources.
Journal of Gastrointestinal SurgeryHospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population
98 Citations2000Marko Šimunović, Teresa To +7 more
The absence of a hospital volume or teaching status effect on treatment and outcome measures suggests that for rectal cancer surgery in Ontario, centralization of procedures into high-volume or teaching centers is unlikely to improve surgical quality.
CirculationEvolution of the Volume-Outcome Relation for Hospitals Performing Coronary Angioplasty
97 Citations2000Vivian Ho
Over time, the disparity in outcomes between low- and high-volume hospitals has narrowed, and outcomes have improved significantly for all hospitals, and lower minimum volume standards may be advisable in less populated areas.
Medical CareDoes Practice Make Perfect?
92 Citations1998Barton H. Hamilton, Vivian Ho
The volume-outcome relationship for hip fracture patients appears to reflect fixed differences in quality between high-volume and low-volume hospitals, which does not support the "practice makes perfect" hypothesis.
The Annals of Thoracic SurgeryNo continuous relationship between veterans affairs hospital coronary artery bypass grafting surgical volume and operative mortality
89 Citations1996A. Laurie Shroyer, Guillermo Marshall +5 more
Annals of Vascular SurgeryOutcome Analysis of Carotid Endarterectomy in Connecticut: The Impact of Volume and Specialty
88 Citations1996Steven T. Ruby, Diane Robinson +2 more
Overall there was a statistically significant correlation between a surgeon's annual volume and outcome, particularly for general surgeons.
Journal of neurosurgeryMortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences
86 Citations1997Christopher L. Taylor, Žhong Yuan +3 more
The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed forSAH in patients 65 years of age or older at a given institution.
Annals of Internal MedicineCarotid Endarterectomy for Elderly Patients: Predicting Complications
85 Citations1990Robert H. Brook, R E Park +4 more
The objective is to determine whether the complication or death rate from carotid endarterectomy can be predicted from hospital and physician structural variables, such as the hospital's teaching status and the doctor's clinical practice at the time of surgery.
Medical CareThe Association of Hospital Volumes of Percutaneous Transluminal Coronary Angioplasty With Adverse Outcomes, Length of Stay, and Charges in California
85 Citations1995Kathryn A. Phillips, Harold S. Luft +1 more
The associations of volumes and outcomes were generally consistent for both unadjusted and adjusted analyses, for patients with and without principal diagnoses of acute myocardial infarction, and using different methods and functional forms.
Journal of Vascular SurgeryThe influence of surgical specialty and caseload on the results of carotid endarterectomy
85 Citations1986Richard F. Kempczinski, Thomas G. Brott +1 more
It is concluded that community-wide results for carotid endarterectomy were not comparable to those previously published from specialized centers and that these results did not appear to be influenced by the type of formal surgical specialty or operative caseload.
Journal of Epidemiology & Community HealthHospital volume, calendar age, and short term outcomes in patients undergoing repair of abdominal aortic aneurysms: the Ontario experience, 1988-92.
82 Citations1996Shi Wu Wen, Marko Šimunović +3 more
The relationship between hospital volume and mortality or morbidity was very modest and observed only for elective surgery, and the excess risk of postoperative death in ruptured as compared to unruptured aneurysms was substantially higher in older patients.
British Journal of UrologyDeaths and complications following prostatectomy in 1400 men in the Northern Region of England
79 Citations1994Andrew Thorpe, R. CLEARLY +4 more
The overall early mortality rate after TURP for benign prostatic hyperplasia across the Region compares well with other reported large series and suggests that careful attention needs to be paid by Urologists, Purchasers and Providers to morbidity rates after prostatectomy.
Journal of the American College of CardiologyThe relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994–1996
74 Citations1999David J. Malenka, Paul McGrath +13 more
There is no significant relationship between operator volumes averaging > or = 68 per year and outcomes at high volume hospitals and future efforts should be directed at determining the generalizability of these results.
Journal of the American College of CardiologyOperator Volume and Outcomes in 12,988 Percutaneous Coronary Interventions fn1fn1This study was supported in part by Grant HS06813 from the Agency for Health Care Policy and Research.
68 Citations1998Paul McGrath, David E. Wennberg +13 more
There is a significant relation between operator volume and outcomes in PCIs and efforts should be directed toward understanding why high volume operators are more successful and encounter fewer adverse outcomes.
American Journal of Medical QualityThe Effects of Regionalization on Clinical Outcomes for a High Risk Surgical Procedure: A Study of the Whipple Procedure in New York State
68 Citations1996Pascal James Imperato, Raphael P. Nenner +4 more
The results of this study demonstrate that there is significant value in re gionalization for even relatively lower volume high risk surgical procedures.
SurgeryPopulation-based analysis of treatment of pancreatic cancer and Whipple resection: Department of Defense hospitals, 1989–1994
63 Citations1996Terence P. Wade, Issam A. Halaby +3 more
Because the DOD medical system minimizes financial and logistic barriers to transfer, the even distribution of DOD pancreatectomy mortality suggests that these barriers may favorably influence single institutional outcomes.
Health EconomicsEstimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects
62 Citations1997Barton H. Hamilton, Vivian H. Hamilton
The volume-outcome relationship for hip fracture patients thus appears to reflect quality differences between high and low volume hospitals, rather than differences within hospitals over time.
Survey of AnesthesiologyImpact of Hospital Volume on Operative Mortality for Major Cancer Surgery
62 Citations1999Colin B. Begg, Laura D. Cramer +2 more
European Journal of Vascular and Endovascular SurgeryREVIEW ARTICLE: Is there a Positive Volume–Outcome Relationship in Peripheral Vascular Surgery? Results of a Systematic Review
57 Citations2000Phil Shackley, Russell Slack +2 more
Results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design.
PubMedOutcomes of surgery among the Medicare aged: surgical volume and mortality.
56 Citations1985Gerald F. Riley, James Lubitz
Examination of the relation between surgical volume and mortality, within 60 days of surgery, for eight procedures on aged Medicare beneficiaries revealed that high surgical volume was significantly associated with lower mortality for resection of the intestine, coronary artery bypass, transurethral resection, and hip arthroplasty.
PubMedAre complication rates for elective primary total hip arthroplasty in Ontario related to surgeon and hospital volumes? A preliminary investigation.
54 Citations1998Hans J. Kreder, Jack I. Williams +4 more
There is no evidence to support regionalization of elective hip replacement surgery in Ontario based on adverse clinical outcomes and surgeons who perform a large number of total hip replacements are discharging patients earlier than less experienced surgeons, without any-demonstrable increase in complications leading to hospital readmission.
PubMedAbdominal aortic aneurysms. Is there an association between surgical volume, surgical experience, hospital type and operative mortality? Members of the Norwegian Abdominal Aortic Aneurysm Trial.
52 Citations1990S Amundsen, Rolv Skjærven +2 more
Outcome of treatment after operations for abdominal aortic aneurysm was related to number of operations carried out and experience, whereas the type of hospital seemed less important, and there was no difference in operative mortality between university, county and local hospitals.
Survey of AnesthesiologyOrganizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery
51 Citations2000Peter J. Pronovost, Mollie W. Jenckes +6 more
Acta Orthopaedica ScandinavicaThe effect of hospital-type and operating volume on the survival of hip replacements: A review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, 1988-1996
50 Citations1999Birgitte Espehaug, Leif I Havelin +2 more
In uncemented THRs, survival results were similar in central and local hospitals, whereas the adjusted revision rate at university hospitals was 1.6 (CI: 1.13-2.19) times that of local hospitals.
PubMedRelation between hospital experience and in-hospital mortality for patients with AIDS-related Pneumocystis carinii pneumonia: experience from 3,126 cases in New York City in 1987.
50 Citations1992Charles L. Bennett, John Adams +6 more
It is suggested that hospital experience may decrease mortality in this subset of patients with human immunodeficiency virus disease, although it is unknown whether this is due to differences in quality of care.
…