To the Editor: In their study on the influence of
hospital volume and surgical volume on 30-day mortality after major
operative procedures in patients with cancer, Dr Begg and
colleagues1 attempt to address a complex and difficult task
with an elegant approach. However, this study cannot address 1
important association of quality outcome.
While a high-volume center is more likely to achieve better outcome,
excellent outcome is still feasible in low-volume centers under certain
circumstances. For instance, Begg et al list zero mortality after
pancreatectomy in 5 hospitals with only 5 patients each during the
study interval of 10 years. At the City of Hope National Medical
Center, a "low-volume" institution according to a definition
offered by Lieberman et al,2 54 patients have undergone
partial or total pancreatectomy between 1988 and 1998, including 50 for
a diagnosis of cancer. Nine surgeons performed a median of 6 such
procedures during this time period (range, 2-8). All surgical
oncologists were fellowship- or specialty-trained, most in high-volume
cancer centers. Thirty-day or in-hospital mortality was zero. The
median length of stay (LOS) was 16.5 days (12 days since 1994). The
median postoperative survival, depending on cancer site, ranged from
22.5 months (pancreatic) to 56 months (ampullary and bile duct).
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
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dhildhood mortality and growth failure data and their association with maternal
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