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Ann Thorac Surg 2001;72:340-341
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a Department of Surgery, McMaster University, St. Joseph Hospital, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada

e-mail: urschelj@mcmaster.ca

There is an inverse relationship between hospital volume and in-hospital mortality for complex operations, such as esophagectomy for esophageal cancer. The report of Dimick and coauthors validates this relationship. Although this hospital volume-outcome relationship seems intuitively obvious the authors correctly point out several important uncertainties. To what extent are low-risk patients referred, or self-referred, to high-volume centers (selective referral hypothesis)? Can the relationship simply be explained by improvements . . . [Full Text of this Article]

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