Influence of Hospital Volume on Mortality Following Major Cancer Surgery

To the Editor: The article by Dr Begg and colleagues¹ examing hospital volume and outcome of major cancer surgery has likely reinforced the notion that many persons at tertiary and quaternary medical centers already had about their superiority in care delivery. Based on my review of the data presented, if I were to need an esophagectomy, I would avoid the study group of physicians at the high-volume hospitals and perhaps at the low-volume centers. The low- and intermediate-volume centers had patients with more comorbidities (25% and 20% vs 11%), and the intermediate-volume centers had more patients with distant disease than the high-volume centers (16% vs 3%), yet the mortality at the high-volume center was no better than the intermediate-volume centers. Further, considering the significantly sicker patients in the low-volume centers, I find it unacceptable to rank these centers as inferior, particularly in regard to this high-risk surgery. As an intensivist, I find no surgery so prone to disastrous, life-threatening complications as an esophagectomy in a patient who also has chronic pulmonary disease or cardiac disease.