RT Journal
A1 Hughes CM
T1 INfluence of hospital volume on mortality following major cancer surgery
JF JAMA
JO JAMA
YR 1999
FD April 21
VO 281
IS 15
SP 1374
OP 1374
DO 10-1001/pubs.JAMA-ISSN-0098-7484-281-15-jbk0421
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-281-15-jbk0421
AB 
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.