Higher hospital volume and specialisation

  • Lyman S
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Outcomes are better in hospitals that do more procedures The first 150 words of the full text of this article appear below. 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 . . . [Full text of this article] Stephen Lyman, associate professor of public health and director of epidemiology and biostatistics 1 Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA lymans@hss.edu

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