title: Relationship between patient safety and hospital surgical volume.
abstract: OBJECTIVE
  To examine the relationship between hospital volume and in-hospital adverse events.
  
  
  METHODS
  Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.
  
  
  METHODS
  In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.
  
  
  RESULTS
  Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).
  
  
  CONCLUSIONS
  These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94306, USA. boussard@stanford.edu
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.forename: John R
authors.initials: JR
authors.lastname: Downey
authors.forename: Kathryn
authors.initials: K
authors.lastname: McDonald
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D006276:Health Facility Size / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States
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