In this issue of The Journal, Kimmel and colleagues1 present important evidence from the data registry of the Society for Cardiac Angiography and Interventions (SCA&I) that the inverse relationship documented to exist between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed at a hospital and the rate of major complications related to the procedure at that institution is independent of differences in patients' risk profile. Although it may seem intuitively clear that procedural volume should bear a meaningful relationship to patient outcome, the argument is made that any observed differences in outcomes between lower-volume and higher-volume laboratories and operators are likely due to the fact that those with lower procedural volumes more often deal with a higher-risk population comprising patients who are sicker, in need of more urgent care, and unsuitable for transfer to higher-volume centers.
Although this argument has been refuted for a number of selected
Ryan TJ. The Critical Question of Procedure Volume Minimums for Coronary Angioplasty. JAMA. 1995;274(14):1169-1170. doi:10.1001/jama.1995.03530140081037