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John D. Birkmeyer, MD

JAMA. 2000;283:1191-1193.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Each year a large number of patients die following elective surgery. In the Medicare population alone, 17,000 patients died in 1995 after undergoing 10 types of elective procedures, such as coronary artery bypass surgery, carotid endarterectomy, and lung resection.¹ Quality improvement initiatives at the local and regional levels may be important for reducing mortality at individual hospitals,^2-3 but, for many procedures, choosing at which hospitals surgery is performed may be equally important for improving surgical quality.

The idea of concentrating high-risk surgical procedures in high-volume hospitals is not new. Since seminal work by Luft et al⁴ 2 decades ago, large, population-based studies have consistently demonstrated better outcomes at high-volume centers for cardiovascular surgery, major cancer resections, solid organ transplantation, and other high-risk procedures.^5-8 Lower surgical mortality at high-volume hospitals does not simply reflect the presence of more skillful surgeons and fewer technical errors with the procedure . . . [Full Text of this Article]

Author Affiliation: Veterans Affairs Medical Center, White River Junction, Vt, and Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

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