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April 21, 1999

Influence of Hospital Volume on Mortality Following Major Cancer Surgery

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(15):1374. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-15-jbk0421

To the Editor: By limiting operative mortality to 30 days after admission (an accepted although arbitrary time post), Dr Begg and colleagues1 may have dampened the significance of their finding that operative mortality was greater in low-volume vs high-volume hospitals for 4 of the 5 procedures examined. Improved postoperative care can prolong life beyond 30 days in many patients who develop severe complications—especially important if patients are transferred postoperatively from low-volume to high-volume centers. Also, the LOS for the procedures selected often exceeds 30 days, suggesting that operative deaths past this point are to be expected. For example, for pancreatic surgery, the mean LOS in their referenced New York and Maryland studies ranged from 22 to 25 days and 22.5 to 27.9 days, respectively.2,3

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