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Quality Wrapped in Volume Inside a Hospital

Peter B. Bach, MD, MAPP
[+] Article, Author, and Disclosure Information

From Memorial Sloan-Kettering Cancer Center, New York, NY 10065.

Potential Financial Conflicts of Interest:Other: Member of the Committee on Performance Measurement of the National Committee for Quality Assurance.

Requests for Single Reprints: Peter B. Bach, MD, MAPP, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 221, New York, NY 10065.

Ann Intern Med. 2009;150(10):729-730. doi:10.7326/0003-4819-150-10-200905190-00013
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Studies that documented surgical outcome differences proliferated in the late 1990s. High-volume hospitals (that is, those that performed larger numbers of a particular procedure) tended to have better outcomes than their lower-volume peers (1). Nested within these findings was a similar volume–outcome relationship for surgeons (2). When low- and high-volume hospitals were compared, some outcome gaps were very large. Begg and colleagues (3) reported a 14% absolute difference in 30-day mortality rates among patients who had esophagectomy for esophageal cancer. Other gaps were modest. Schrag and coworkers (4) reported a 2% absolute difference in mortality rates 30 days after colorectal cancer surgery. Investigators have also identified a volume–outcome relationship for coronary artery bypass grafting, which has been weak in some studies and stronger in others (5).

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