You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 262 No. 4, July 28, 1989 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Original Contributions
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals

Edward L. Hannan, PhD; Joseph F. O'Donnell, MA, MS; Harold Kilburn, Jr, MA; Harvey R. Bernard, MD; Altan Yazici, MBA

JAMA. 1989;262(4):503-510.


Abstract

Recent studies have demonstrated that the number of times a hospital or surgeon performs certain procedures annually has an inverse relationship with in-hospital mortality rates for patients undergoing the procedures. This study uses an improved measure of physician volume to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers. Five procedure groups have significant volume-mortality relationships. For total cholecystectomies, hospital volume is the more significant volume measure, but physician volume is marginally related to mortality rate. For coronary artery bypass surgeries, resection of abdominal aortic aneurysms, partial gastrectomies, and colectomies, physician volume is more significant than hospital volume, but hospital volume is marginally significant. Annual hospital volume thresholds for these data appear to exist at approximately 5 procedures for partial gastrectomies, 40 procedures for colectomies, and 170 procedures for total cholecystectomies.

(JAMA. 1989;262:503-510)



Author Affiliations

From the Office of Health Systems Management, New York State Department of Health, Albany (Drs Hannan and Bernard and Messrs O'Donnell, Kilburn, and Yazici); and Albany (NY) Medical Center Hospital (Dr Bernard).


Footnotes

Reprint requests to Office of Health Systems Management, New York State Department of Health, Room 2019, Empire State Plaza Tower Bldg, Albany, NY 12237 (Dr Hannan).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
Konety et al.
J. Thorac. Cardiovasc. Surg. 2009;137:1116-23.e1.
ABSTRACT | FULL TEXT  

The Effect of Provider Case Volume on Cancer Mortality: Systematic Review and Meta-Analysis
Gruen et al.
CA Cancer J Clin 2009;59:192-211.
ABSTRACT | FULL TEXT  

The public health hazards of risk avoidance associated with public reporting of risk-adjusted outcomes in coronary intervention.
Resnic and Welt
J Am Coll Cardiol 2009;53:825-830.
ABSTRACT | FULL TEXT  

Public Health Reporting: The United States Perspective
Halpin et al.
SEMIN CARDIOTHORAC VASC ANESTH 2008;12:191-202.
ABSTRACT  

Does the choice of risk-adjustment model influence the outcome of surgeon-specific mortality analysis? A retrospective analysis of 14 637 patients under 31 surgeons
Grant et al.
Heart 2008;94:1044-1049.
ABSTRACT | FULL TEXT  

Volume-outcome relationships in coronary artery bypass graft surgery patients: 5-year major cardiovascular event outcomes.
Lin et al.
J. Thorac. Cardiovasc. Surg. 2008;135:923-930.
ABSTRACT | FULL TEXT  

Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume
Ricciardi et al.
Arch Surg 2008;143:338-344.
ABSTRACT | FULL TEXT  

The Impact of Trauma-Center Care on Functional Outcomes Following Major Lower-Limb Trauma
MacKenzie et al.
JBJS 2008;90:101-109.
ABSTRACT | FULL TEXT  

Risk Stratification and Comorbidity
Ferraris et al.
Card Surg Adult 2008;3:199-246.
FULL TEXT  

Quality Assessment in High-Acuity Surgery: Volume and Mortality Are Not Enough
Vollmer et al.
Arch Surg 2007;142:371-380.
ABSTRACT | FULL TEXT  

UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation
Price et al.
Thorax 2006;61:837-842.
ABSTRACT | FULL TEXT  

Hospital volume and the outcomes of mechanical ventilation.
Kahn et al.
NEJM 2006;355:41-50.
ABSTRACT | FULL TEXT  

Association Between Surgeon and Hospital Volume in Coronary Artery Bypass Graft Surgery Outcomes: A Population-Based Study
Wen et al.
Ann. Thorac. Surg. 2006;81:835-842.
ABSTRACT | FULL TEXT  

Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery
Welke et al.
Ann. Thorac. Surg. 2005;80:2114-2119.
ABSTRACT | FULL TEXT  

Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients
Skinner et al.
Circulation 2005;112:2634-2641.
ABSTRACT | FULL TEXT  

Practical virtue ethics: healthcare whistleblowing and portable digital technology
Bolsin et al.
J. Med. Ethics 2005;31:612-618.
ABSTRACT | FULL TEXT  

Measuring Percutaneous Coronary Intervention Quality by Simple Case Volume
Kuntz and Normand
Circulation 2005;112:1088-1091.
FULL TEXT  

The Relation Between Surgeon Volume and Outcome Following Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery
Glance et al.
Chest 2005;128:829-837.
ABSTRACT | FULL TEXT  

Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and Midterm Outcomes
Zacharias et al.
Ann. Thorac. Surg. 2005;79:1961-1969.
ABSTRACT | FULL TEXT  

Hospital Volume and Selection of Valve Type in Older Patients Undergoing Aortic Valve Replacement Surgery in the United States
Schelbert et al.
Circulation 2005;111:2178-2182.
ABSTRACT | FULL TEXT  

A Minimal-Incision Technique in Total Hip Arthroplasty Does Not Improve Early Postoperative Outcomes. A Prospective, Randomized, Controlled Trial
Ogonda et al.
JBJS 2005;87:701-710.
ABSTRACT | FULL TEXT  

Effects of Race, Insurance Status, and Hospital Volume on Perforated Appendicitis in Children
Smink et al.
Pediatrics 2005;115:920-925.
ABSTRACT | FULL TEXT  

Impact of Patient Risk on the Hospital Volume-Outcome Relationship in Coronary Artery Bypass Grafting
Nallamothu et al.
Arch Intern Med 2005;165:333-337.
ABSTRACT | FULL TEXT  

Training Residents in Mitral Valve Surgery
Baskett et al.
Ann. Thorac. Surg. 2004;78:1236-1240.
ABSTRACT | FULL TEXT  

Improving mortality of coronary surgery over first four years of independent practice: retrospective examination of prospectively collected data from 15 surgeons
Bridgewater et al.
BMJ 2004;329:421.
ABSTRACT | FULL TEXT  

Is the Impact of Hospital and Surgeon Volumes on the In-Hospital Mortality Rate for Coronary Artery Bypass Graft Surgery Limited to Patients at High Risk?
Wu et al.
Circulation 2004;110:784-789.
ABSTRACT | FULL TEXT  

Explaining disparities in access to high-quality cardiac surgeons
Rothenberg et al.
Ann. Thorac. Surg. 2004;78:18-24.
ABSTRACT | FULL TEXT  

The relation of volume with outcome in phacoemulsification surgery
Habib et al.
Br J Ophthalmol 2004;88:643-646.
ABSTRACT | FULL TEXT  

Procedural Volume as a Marker of Quality for CABG Surgery
Peterson et al.
JAMA 2004;291:195-201.
ABSTRACT | FULL TEXT  

Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study
Meyerhardt et al.
JCO 2004;22:166-174.
ABSTRACT | FULL TEXT  

The Effect of Hospital Volume of Pediatric Appendectomies on the Misdiagnosis of Appendicitis in Children
Smink et al.
Pediatrics 2004;113:18-23.
ABSTRACT | FULL TEXT  

National Variation in Operative Mortality Rates for Esophageal Resection and the Need for Quality Improvement
Dimick et al.
Arch Surg 2003;138:1305-1309.
ABSTRACT | FULL TEXT  

Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence
Meyerhardt et al.
ANN INTERN MED 2003;139:649-657.
ABSTRACT | FULL TEXT  

The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes
Panageas et al.
ANN INTERN MED 2003;139:658-665.
ABSTRACT | FULL TEXT  

Is the hospital volume-mortality relationship in coronary artery bypass surgery the same for low-risk versus high-risk patients?
Glance et al.
Ann. Thorac. Surg. 2003;76:1155-1162.
ABSTRACT | FULL TEXT  

Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample
Hervey et al.
JBJS 2003;85:1775-1783.
ABSTRACT | FULL TEXT  

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Chen et al.
Circulation 2003;108:951-957.
ABSTRACT | FULL TEXT  

Do Hospitals and Surgeons With Higher Coronary Artery Bypass Graft Surgery Volumes Still Have Lower Risk-Adjusted Mortality Rates?
Hannan et al.
Circulation 2003;108:795-801.
ABSTRACT | FULL TEXT  

Financing Graduate Medical Education: Sorting Out the Confusion
Covey and Friedlaender
JBJS 2003;85:1594-1604.
FULL TEXT  

Hospital Volume and Operative Mortality in Cancer Surgery: A National Study
Finlayson et al.
Arch Surg 2003;138:721-725.
ABSTRACT | FULL TEXT  

Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth
Clark et al.
Pediatrics 2003;112:203-204.
FULL TEXT  

Accepting Critically Ill Transfer Patients: Adverse Effect on a Referral Center's Outcome and Benchmark Measures
Rosenberg et al.
ANN INTERN MED 2003;138:882-890.
ABSTRACT | FULL TEXT  

Volume Expansion With Albumin Decreases Mortality After Coronary Artery Bypass Graft Surgery
Sedrakyan et al.
Chest 2003;123:1853-1857.
ABSTRACT | FULL TEXT  

Quality-of-Care Indicators for Early-Stage Prostate Cancer
Spencer et al.
JCO 2003;21:1928-1936.
ABSTRACT | FULL TEXT  

The volume-outcome relationship: from Luft to Leapfrog
Shahian and Normand
Ann. Thorac. Surg. 2003;75:1048-1058.
ABSTRACT | FULL TEXT  

Hospital experience and outcomes for esophageal variceal bleeding
MORSS DY et al.
Int J Qual Health Care 2003;15:139-146.
ABSTRACT | FULL TEXT  

Making the case for personal professional monitoring in health care
Bolsin and Colson
Int J Qual Health Care 2003;15:1-2.
FULL TEXT  

Role of Surgeon Volume in Radical Prostatectomy Outcomes
Hu et al.
JCO 2003;21:401-405.
ABSTRACT | FULL TEXT  

Hepatic Resection in the United States: Indications, Outcomes, and Hospital Procedural Volumes From a Nationally Representative Database
Dimick et al.
Arch Surg 2003;138:185-191.
ABSTRACT | FULL TEXT  

Postoperative Complication Rates After Hepatic Resection in Maryland Hospitals
Dimick et al.
Arch Surg 2003;138:41-46.
ABSTRACT | FULL TEXT  

Risk Stratification and Comorbidity
Ferraris and Ferraris
Card Surg Adult 2003;2:187-224.
FULL TEXT  

Hospital and Surgeon Determinants of Carotid Endarterectomy Outcomes
Feasby et al.
Arch Neurol 2002;59:1877-1881.
ABSTRACT | FULL TEXT  

Mortality in Medicare Beneficiaries Following Coronary Artery Bypass Graft Surgery in States With and Without Certificate of Need Regulation
Vaughan-Sarrazin et al.
JAMA 2002;288:1859-1866.
ABSTRACT | FULL TEXT  

Is it safe to train residents to perform cardiac surgery?
Baskett et al.
Ann. Thorac. Surg. 2002;74:1043-1049.
ABSTRACT | FULL TEXT  

Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
Halm et al.
ANN INTERN MED 2002;137:511-520.
ABSTRACT | FULL TEXT  

Female Sex as a Risk Factor for In-Hospital Mortality Among Children Undergoing Cardiac Surgery
Chang et al.
Circulation 2002;106:1514-1522.
ABSTRACT | FULL TEXT  

Association Between Hospital and Surgeon Procedure Volume and Outcomes of Orthopaedic Surgery: Caveats for Interpretation of Data and Policy Applications
Saroff et al.
JBJS 2002;84:1715-1717.
FULL TEXT  

A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals
Devereaux et al.
CMAJ 2002;166:1399-1406.
ABSTRACT | FULL TEXT  

Hospital Volume and Surgical Mortality in the United States
Birkmeyer et al.
NEJM 2002;346:1128-1137.
ABSTRACT | FULL TEXT  

The Vermont Colorectal Cancer Project: Self-portrait
Hyman et al.
Arch Surg 2002;137:413-416.
ABSTRACT | FULL TEXT  

The role of hospital volume in coronary artery bypass grafting: is more always better?
Nallamothu et al.
J Am Coll Cardiol 2001;38:1923-1930.
ABSTRACT | FULL TEXT  

Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population
Katz et al.
JBJS 2001;83:1622-1629.
ABSTRACT | FULL TEXT  

Comparing clinical outcomes in high-volume and low-volume off-pump coronary bypass operation programs
Brown et al.
Ann. Thorac. Surg. 2001;72:S1009-1015.
ABSTRACT | FULL TEXT  

The Influence of Hospital Volume on Survival after Resection for Lung Cancer
Bach et al.
NEJM 2001;345:181-188.
ABSTRACT | FULL TEXT  

Relationship of hospital size, case volume, and cost for coronary artery bypass surgery: Analysis of 12,774 patients operated on in Massachusetts during fiscal years 1995 and 1996
Shahian et al.
J. Thorac. Cardiovasc. Surg. 2001;122:53-64.
ABSTRACT | FULL TEXT  

A case study of hospital closure and centralization of coronary revascularization procedures
Hemmelgarn et al.
CMAJ 2001;164:1431-1435.
ABSTRACT | FULL TEXT  

Complications of Elbow Arthroscopy
Kelly et al.
JBJS 2001;83:25-25.
ABSTRACT | FULL TEXT  

Relation Between Hospital Primary Angioplasty Volume and Mortality for Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic Therapy
Magid et al.
JAMA 2000;284:3131-3138.
ABSTRACT | FULL TEXT  

Relation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
McGrath et al.
JAMA 2000;284:3139-3144.
ABSTRACT | FULL TEXT  

Influence of Hospital Procedure Volume on Outcomes Following Surgery for Colon Cancer
Schrag et al.
JAMA 2000;284:3028-3035.
ABSTRACT | FULL TEXT  

The Use of Quality Indicators for Assessing Radical Prostatectomy Specimens
Imperato et al.
American Journal of Medical Quality 2000;15:212-220.
ABSTRACT  

Volume-Outcome Relationships in Pediatric Intensive Care Units
Tilford et al.
Pediatrics 2000;106:289-294.
ABSTRACT | FULL TEXT  

The Volume of Primary Angioplasty Procedures and Survival after Acute Myocardial Infarction
Canto et al.
NEJM 2000;342:1573-1580.
ABSTRACT | FULL TEXT  

Assessing quality in cardiac surgery: why this is necessary in the twenty-first century
Swain and Hartz
Perfusion 2000;15:181-190.
ABSTRACT  

Selective Referral to High-Volume Hospitals: Estimating Potentially Avoidable Deaths
Dudley et al.
JAMA 2000;283:1159-1166.
ABSTRACT | FULL TEXT  

Excellence and low case volume: an example of the inapplicability of volume-based credentialing
Early and Roberts
Ann. Thorac. Surg. 2000;69:146-150.
ABSTRACT | FULL TEXT  

ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)
Eagle et al.
J Am Coll Cardiol 1999;34:1262-1347.
FULL TEXT  

A 5-year Post-operative Review of Secondary Alveolar Bone Grafting in the Yorkshire Region
Kindelan and Roberts-Harry
J. Orthod. 1999;26:211-217.
ABSTRACT | FULL TEXT  

Health Maintenance Organizations and Hospital Quality for Coronary Artery Bypass Surgery
Escarce et al.
Med Care Res Rev 1999;56:340-362.
ABSTRACT  

Commentary
Hannan
Med Care Res Rev 1999;56:363-372.
 

Relationship Between Rates and Outcomes of Operative Treatment for Lumbar Disc Herniation and Spinal Stenosis
KELLER et al.
JBJS 1999;81:752-62.
ABSTRACT | FULL TEXT  

Influence of hospital and clinician workload on survival from colorectal cancer: cohort study • Commentary: How experienced should a colorectal surgeon be?
Kee et al.
BMJ 1999;318:1381-1386.
ABSTRACT | FULL TEXT  

Volume-Outcome Relationships In Cardiovascular Operations: New York State, 1990-1995
Sollano et al.
J. Thorac. Cardiovasc. Surg. 1999;117:419-430.
ABSTRACT | FULL TEXT  

Community-Wide Assessment of Intensive Care Outcomes Using a Physiologically Based Prognostic Measure: Implications for Critical Care Delivery From Cleveland Health Quality Choice
Sirio et al.
Chest 1999;115:793-801.
ABSTRACT | FULL TEXT  

An Employer's Perspective on Hospitalists as a Source of Improved Health Care Value
Milstein
ANN INTERN MED 1999;130:360-363.
ABSTRACT | FULL TEXT  

The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma
Glasgow et al.
Arch Surg 1999;134:30-35.
ABSTRACT | FULL TEXT  

Relationship Between Provider Volume and Mortality for Carotid Endarterectomies in New York State
Hannan et al.
Stroke 1998;29:2292-2297.
ABSTRACT | FULL TEXT  

Center-Specific Graft and Patient Survival Rates: 1997 United Network for Organ Sharing (UNOS) Report
Lin et al.
JAMA 1998;280:1153-1160.
ABSTRACT | FULL TEXT  

Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction
Casale et al.
J Am Coll Cardiol 1998;32:885-889.
ABSTRACT | FULL TEXT  

Operator volume and outcome of patients undergoing coronary stent placement
Kastrati et al.
J Am Coll Cardiol 1998;32:970-976.
ABSTRACT | FULL TEXT  

Effect of Surgeon Expertise on the Outcome in Primary Hyperparathyroidism
Willeke et al.
Arch Surg 1998;133:1066-1070.
ABSTRACT | FULL TEXT  

Thresholds for Surgery and Surgical Outcomes for Patients with Primary Hyperparathyroidism: A National Survey of Endocrine Surgeons
Sosa et al.
J. Clin. Endocrinol. Metab. 1998;83:2658-2665.
ABSTRACT | FULL TEXT  

Pediatric Cardiac Surgery: The Effect of Hospital and Surgeon Volume on In-hospital Mortality
Hannan et al.
Pediatrics 1998;101:963-969.
ABSTRACT | FULL TEXT  

The Impact of Regionalization on a Surgery Program in the Canadian Health Care System
Hamilton et al.
Arch Surg 1997;132:605-610.
ABSTRACT  

Coronary Angioplasty Volume-Outcome Relationships for Hospitals and Cardiologists
Hannan et al.
JAMA 1997;277:892-898.
ABSTRACT  

The Learning Curve for Laparoscopic Colorectal Surgery: Preliminary Results From a Prospective Analysis of 1194 Laparoscopic-Assisted Colectomies
Bennett et al.
Arch Surg 1997;132:41-44.
ABSTRACT  

The Effects of Regionalization on Clinical Outcomes for a High Risk Surgical Procedure: A Study of the Whipple Procedure in New York State
Imperato et al.
American Journal of Medical Quality 1996;11:193-197.
ABSTRACT  

The Emerging Role of "Hospitalists" in the American Health Care System
Wachter and Goldman
NEJM 1996;335:514-517.
FULL TEXT  

Benefits and Hazards of Reporting Medical Outcomes Publicly
Chassin et al.
NEJM 1996;334:394-398.
FULL TEXT  

Analysis and Comparison of Operator-Specific Outcomes in Interventional Cardiology : From a Multicenter Database of 4860 Quality-Controlled Procedures
Ellis et al.
Circulation 1996;93:431-439.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1989 American Medical Association. All Rights Reserved.