Editorials

Higher hospital volume and specialisation

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c160 (Published 11 February 2010) Cite this as: BMJ 2010;340:c160
  1. Stephen Lyman, associate professor of public health and director of epidemiology and biostatistics
  1. 1Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
  1. lymans@hss.edu

    Outcomes are better in hospitals that do more procedures

    The association between surgical volume and patient outcomes for total joint replacement and other surgical procedures has been examined extensively.1 2 3 4 5 The reasons why surgeons who perform a higher volume of cases have better outcomes are intuitive. Surgeons who have more experience with a procedure tend to deliver better outcomes—after all, “practice makes perfect,” even beyond the learning curve.

    What is less well understood is why a hospital procedural volume-outcome association persists even after adjusting for surgeon volume. Patients operated on by lower volume surgeons in high volume hospitals still have better outcomes than those operated on by similar volume surgeons in lower volume hospitals. This effect is thought to result from improved care processes in higher volume hospitals.

    In the linked study (doi:10.1136/bmj.c165), Hagen and colleagues examine one possible explanation for this hospital volume-outcome association.6 They show that hospitals that specialise in orthopaedic surgery have better patient outcomes for total joint …

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