RT Journal
A1 Davies RJ
T1 HOspital volume and operative mortality in cancer surgery—invited critique
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD July 1
VO 138
IS 7
SP 726
OP 726
DO 10.1001/archsurg.138.7.726
UL http://dx.doi.org/10.1001/archsurg.138.7.726
AB 
The studies by Finlayson et al and others support the notion that operative mortality is higher in low-volume hospitals. However, several questions remain: What factors are responsible for the higher mortality? Is it because of poor patient selection, more comorbidities, or inferior perioperative treatment at low-volume hospitals? Is it because patients with tumors that have a better prognosis select higher-volume hospitals? Are the surgical skills of practioners at high-volume hospitals significantly superior to those at low-volume hospitals? Are those skills transferable, or should patients with certain malignancies be transferred to high-volume units? Finally, how do we define volume? Does a low-volume surgeon at a high-volume hospital have better results than this surgeon's counterpart practicing in a low-volume hospital?