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Surgeon Volume vs Hospital Volume: Which Matters More?-Reply

Edward L. Hannan, PhD; Joseph O'Donnell, MA, MS; Harold Kilburn Jr, MA; Harvey Bernard, MD; Altan Yazici, MBA
JAMA. 1990;263(11):1493. doi:10.1001/jama.1990.03440110054019.
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In Reply.—  The letters regarding our article cover five main points: (1) the potential dangers of directing patients toward higher-volume surgeons and hospitals, (2) the absence of board certification as an explanatory variable, (3) the fact that lower-volume providers operated on higher-risk patients on average, (4) the failure to take into account whether aneurysms were ruptured and whether patients with ruptured aneurysms were stabilized at a low-volume hospital prior to admission to a high-volume hospital, and (5) "picking one variable and assigning it a cause-and-effect relationship in... a cavalier way." These five points are addressed in order.There are certainly potential dangers in directing patients to assembly line clinics that emphasize the volume of patients treated rather than the quality of care. However, the cases in this study are all inpatients who were operated on in hospitals with fairly low volumes by surgeons with surprisingly low volumes of the procedures


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