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Should operations be regionalized? The empirical relation between surgical volume and mortality
The New England Journal of Medicine
|December 20, 1979
Summary
Higher surgical procedure volume in hospitals is linked to lower mortality rates for complex surgeries like open-heart and coronary bypass. This suggests regionalization of certain complex operations may improve patient outcomes.
Area of Science:
- Health Services Research
- Surgical Outcomes Research
Background:
- Hospital surgical volume is a potential indicator of surgical quality.
- The relationship between surgical volume and patient mortality varies by procedure complexity.
Purpose of the Study:
- To investigate the association between hospital surgical volume and surgical mortality for 12 diverse procedures.
- To determine if higher surgical volumes correlate with reduced patient death rates across different types of operations.
Main Methods:
- Analysis of mortality data for 12 surgical procedures across 1498 hospitals.
- Case-mix adjustment to account for patient severity.
- Comparison of mortality rates between high-volume and low-volume hospitals.
Main Results:
- Mortality decreased with increasing volume for complex procedures (e.g., open-heart surgery, coronary bypass).
- Hospitals performing ≥200 complex operations annually had 25-41% lower adjusted mortality rates.
- Some procedures (e.g., total hip replacement) showed mortality rates plateauing at lower volumes, while others (e.g., cholecystectomy) showed no volume-mortality relationship.
Conclusions:
- Surgical volume is significantly associated with reduced mortality for certain complex procedures.
- Findings support the potential benefit of regionalizing specific high-risk surgical procedures.
- Factors like surgeon experience and patient selection may influence the observed volume-outcome relationship.
