Impact of Hospital Volume on Operative Mortality for Major Cancer Surgery

Abstract
A NUMBER of cancer studies have been conducted using hospital volume of patients treated as a measure of surgical expertise, following a tradition of the use of patient volume in studies of variations in outcomes between hospitals and between surgeons.1 In the United States, all population-based studies of this issue have used state discharge databases and in-hospital mortality as the end point, notably the studies of pancreatectomy in New York,2 California,3 and Maryland4; studies of lung cancer in California5; and hepatic resections in Maryland.6 All these studies demonstrated much lower mortality in high-volume hospitals.