Surgeon volume and operative mortality in the United States

Background Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain. Methods Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers. Results Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The adjusted odds ratio for operative death (for patients with a low-volume surgeon vs. those with a high-volume surgeon) varied widely according to the procedure — f...

[1]  J. Birkmeyer,et al.  Hospital Volume and Surgical Mortality in the United States , 2002 .

[2]  C. Begg,et al.  impact of Hospital Volume on Operative Mortality for Major Cancer Surgery , 1999 .

[3]  J. Birkmeyer,et al.  Is surgery getting safer? National trends in operative mortality. , 2002, Journal of the American College of Surgeons.

[4]  E. Halm,et al.  Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy , 2001, Stroke.

[5]  J. Birkmeyer,et al.  Operative mortality with elective surgery in older adults. , 2001, Effective clinical practice : ECP.

[6]  M. Choti,et al.  Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. , 1999, Annals of surgery.

[7]  E. Hannan,et al.  Relationship between provider volume and mortality for carotid endarterectomies in New York state. , 1998, Stroke.

[8]  Colin B Begg,et al.  Variations in morbidity after radical prostatectomy. , 2002, The New England journal of medicine.

[9]  P. McCullagh,et al.  Generalized Linear Models , 1992 .

[10]  F A Sloan,et al.  Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. , 1999, The New England journal of medicine.

[11]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[12]  N. Breslow,et al.  Approximate inference in generalized linear mixed models , 1993 .

[13]  A Milstein,et al.  Selective referral to high-volume hospitals: estimating potentially avoidable deaths. , 2000, JAMA.

[14]  P. McCullagh,et al.  Generalized Linear Models , 1984 .

[15]  E. Fisher,et al.  Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? , 1992, JAMA.

[16]  C. Begg,et al.  Hospital and Surgeon Procedure Volume as Predictors of Outcome Following Rectal Cancer Resection , 2002, Annals of surgery.

[17]  E. Hannan,et al.  The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. , 2002, Surgery.

[18]  E. Fisher,et al.  The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. , 1992, American journal of public health.

[19]  K. Lillemoe,et al.  Importance of hospital volume in the overall management of pancreatic cancer. , 1998, Annals of surgery.

[20]  Ethan A Halm,et al.  Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature , 2002, Annals of Internal Medicine.

[21]  The impact of practicing in multiple hospitals on physician profiles. , 1996, Medical care.

[22]  B. Hillner,et al.  Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.