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Ann Thorac Surg 2005;79:217-218
© 2005 The Society of Thoracic Surgeons

INVITED COMMENTARY

University of Kentucky, C-208, UKMC, 800 Rose St, Lexington, KY 40536

The first 20% of the full text of this article appears below.

The article by Dimick and coworkers addresses an important subject that has gained much national lay-press notoriety in recent weeks, that is, the issue of provider volume affecting patient outcomes [1]. This article engendered divergent opinions from reviewers with some reviewers strongly opposed to publication whereas others were not. I suppose this reflects the current uncertainty about the volume–outcome relationship in surgical patients and the article by Dimick and coauthors deserves some comment [1].

These authors use a claims database from the Agency for Health Research and Quality to identify trends in hospital mortality and length of stay for patients undergoing esophagectomy between 1988 and 2000. The authors conclude that improvements in operative mortality at high-volume hospitals are at least partly responsible for an improving trend in outcomes for esophagectomy. There is a trap inherent in using administrative claims databases to reach conclusions that have clinical implications. Because these data are generated for the collection of bills, their clinical accuracy is inadequate, and it is likely that these databases overestimate complications for billing purposes and underestimate the effects of comorbid illness [2–5]. The quality of databases used to generate comparisons cannot be overemphasized.

Mortality after coronary artery bypass grafting (CABG) is the prototypical procedure . . . [Full Text of this Article]

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