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Ann Thorac Surg 2000;70:1001
© 2000 The Society of Thoracic Surgeons

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Correspondence

Volume–outcome relationship in thoracic surgery

^a St. Joseph’s Hospital, 50 Charlton Ave East, Hamilton, ON, Canada L8N 4A6
^b Surgical Intensive Care Unit, Buffalo General Hospital, Kaleida Health System, Buffalo, NY 14203, USA,

e-mail: urschelj{at}fhs.mcmaster.ca
e-mail: dmurschel{at}ivillage.com

To the Editor

Early and Roberts [1] have shown that good cardiac surgical results can be obtained in a low-volume hospital. However, many other reports have documented a high operative mortality when complex operations are undertaken in low-volume hospitals or by low-volume surgeons [2–4]. There are three major factors responsible for this volume–outcome relationship: skill of the surgeon, experience of the supporting team (anesthesiologists, intensivists, and nurses), and general resources of the hospital [5]. Some studies have stressed the importance of the surgeon [4, 5], whereas others have shown that hospital volume is the most important factor [6]. Skilled surgeons tend to develop busy practices at high-volume tertiary care hospitals, so it is difficult to study the various factors in isolation.

The surgical literature contains other reports of excellent patient outcomes for complex thoracic surgical operations done in low-volume settings [5, 7]. Early and Roberts’ experiences are remarkably similar to those documented in these other reports [5]. These articles emphasize the importance of meticulous perioperative care, and the direct involvement of the surgeon in every detail of patient management. Without this type of commitment by the surgeon, good outcomes cannot be obtained in low-volume thoracic surgical settings. Interestingly, the reports cited above have one other feature in common [1, 5, 7]. It is difficult for surgeons to shoulder the burden of patient care in low-volume hospitals indefinitely; they eventually move to other centers.

References

1. Early G.L., Roberts S.R. Excellence and low case volume. Ann Thorac Surg 2000;69:146-150.[Abstract/Free Full Text]
2. Patti M.G., Corvera C.U., Glasgow R.E., Way L.W. A hospital’s annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg 1998;2:186-192.[Medline]
3. Romano P.S., Mark D.H. Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. Chest 1992;101:1332-1337.[Abstract/Free Full Text]
4. Miller J.D., Jain M.K., de Gara C.J., Morgan D., Urschel J.D. The effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 1997;65:20-21.[Medline]
5. Urschel J.D., Urschel D.M. The hospital volume-outcome relationship in general thoracic surgery. J Cardiovasc Surg 2000;41:153-155.[Medline]
6. Lieberman M.D., Kilburn H., Lindsey M., Brennan M.F. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638-645.[Medline]
7. Reasbeck P.G. Treatment of oesophageal carcinoma at a small rural hospital. J R Coll Surg Edinb 1998;43:314-317.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John D. Urschel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Urschel, J. D. Articles by Urschel, D. M. Search for Related Content PubMed Articles by Urschel, J. D. Articles by Urschel, D. M. Related Collections Related Article