The volume-performance relationship in esophagectomy.
The current literature demonstrates that both hospital volume and surgeon volume are inversely related to operative mortality for esophageal resection. Given the heterogeneity of the volume-outcome literature, it is difficult to identify minimum volume thresholds at which satisfactory performance is achieved. Both volume-based hospital referral and process improvement provide compelling and sometimes competing strategies for translating evidence about volume-outcome relationships into policy. Each approach has significant limitations that preclude uniform implementation nationwide but nonetheless should be a focus for continued investigation and application, with the goal of providing uniform and high-quality care after esophagectomy.
Chang
Andrew C
AC
Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor 48109, USA. andrwchg@umich.edu
Birkmeyer
John D
JD
D002983:Clinical Competence; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome; D016526:Workload