John D Birkmeyer

..Although numerous studies suggest that there is an inverse relation between hospital volume of surgical procedures and surgical mortality, the relative importance of hospital volume in various surgical procedures is disputed...

..Although payers are leading the most visible of these efforts, it is unknown whether volume standards will also reduce resource use...

..Surgical mortality rates are increasingly used to measure hospital quality. It is not clear, however, how many hospitals have sufficient caseloads to reliably identify quality problems...

..We sought to determine if a hospital's performance in CABG is correlated to its performance in heart valve replacement...

..A recent analysis of coronary artery bypass grafting (CABG), however, suggests that volume-based referral initiatives should focus only on high-risk patients...

..When available, comorbidity information from prior hospitalizations may be more useful for risk adjustment...

..Although mortality rates for some cardiovascular procedures seem to have declined, it is unclear whether other high-risk procedures are becoming safer over time...

..Although initiatives to regionalize cancer surgery are already under way, the relative importance of volume in cancer surgery is disputed...

..Further research is needed to determine the appropriate threshold for surgical treatment in patients with gastroesophageal reflux...

..We sought to examine the effect of subspecialty training on operative mortality following lung resection...

..Surgeons with advanced training have lower mortality rates with some surgical procedures. The objective of the current study was to investigate the impact of thoracic surgery training on mortality rates of esophageal cancer resection...

..Further work is needed to understand the mechanisms underlying differences in performance across hospitals in cancer care...

..Statistical power can be improved by combining mortality data from multiple operations. We sought to determine whether this approach would still be useful in understanding performance with individual procedures...

..Other regions had enough cases but too many hospitals performing them. Although consolidation of surgical services may be feasible in some settings, volume-based referral strategies are impractical for many U.S. regions...

..This trend was largely associated with an increase in the use of gastric bypass procedures...

..CONCLUSION: Our model suggests that surgery would likely benefit a high proportion of medically treated GERD patients. Individual assessment of quality of life with GERD should be considered to aid clinical decision making...

..For this reason, we performed a meta-analysis of studies comparing open and laparoscopic ventral (including incisional) hernia repair...

..To learn how patients in Medicare, the US medical insurance programme that covers elderly patients, made decisions about where to undergo major surgery and how they would make future decisions...

..Although proponents argue that specialty cardiac hospitals provide high-quality cost-efficient care, strong financial incentives for physicians at these facilities could result in greater procedure utilization...

..In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery...

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..The current study was conducted to examine relations between hospital volume, process of care, and operative mortality in cancer surgery...

..However, the processes of care that mediate this effect are unknown. We sought to identify the processes that underlie the volume-outcome relationship for cystectomy...

..Investigators should be cognizant of this bias and exercise caution when interpreting these relationships when using SEER-Medicare data alone...

..The National Quality Forum and other organizations recently endorsed a 12-node minimum as a measure of hospital quality...

..Population-based data can provide more realistic estimates of the risks and benefits of operations in this group...

..This study was performed to determine outcomes after transhiatal and transthoracic esophagectomy for patients undergoing resection nationwide...

..We examined the hypothesis that the lower treatment rate for blacks is due to underreferral to medical and radiation oncologists...

..We sought to evaluate the importance of risk-adjustment for two cardiac surgery report cards in New York and Pennsylvania...

..Although racial disparities in the quality of surgical care are well described, the impact of socioeconomic status on operative mortality is relatively unexplored...

..This study describes racial differences in postoperative mortality following 8 cardiovascular and cancer procedures and assesses possible explanations for these differences...

..For some procedures, standards comprised of process of care or direct outcome measures would be more effective than those based on volume alone...

..In the current study, the authors assessed whether patients at NCI cancer centers compared with patients at control hospitals had lower mortality rates after major cancer surgery...

..Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain...

..However, such regionalization policies might cause unreasonable travel burdens for surgical patients...

..Despite growing interest in evidence-based hospital referral for selected surgical procedures, there remains considerable debate about which measures should be used to identify high-quality providers...

..With increasing momentum from outside the profession of surgery, it is particularly important for surgeons to participate in making decisions regarding situations where volume may be an appropriate measure of quality...

..For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs...

..Despite growing calls for using lymph node counts as a hospital quality indicator, it has not been established that hospitals that obtain more lymph node have better outcomes...

..Outcomes of patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) at specialty cardiac hospitals are uncertain...

..Although recent studies suggest that physician age is inversely related to clinical performance in primary care, relationships between surgeon age and patient outcomes have not been examined systematically...

..However, relations between resource availability and utilization are relatively unexplored in cancer care, including perioperative adjuvant therapy...

..Relative to other major surgical procedures, gastric bypass for morbid obesity is associated with substantial gains in life expectancy. Long- term data from prospective studies are needed to confirm this finding...

..The effectiveness in improving survival of neoadjuvant chemoradiotherapy (NCRT) in patients undergoing surgery for esophageal carcinoma remains unclear...

..Although hospital procedure volume is clearly related to operative mortality with many cancer procedures, its effect on late survival is not well characterized...

..Given the magnitude of its clinical and financial impact, hospital leaders should be asking "how to" rather than "whether to" implement The Leapfrog Group's ICU Physician Staffing standard...

..75, P < .005). Cause-specific mortality can be reliably and systematically measured after cancer surgery. Understanding variation in cause-specific mortality can inform future quality improvement efforts...