The studies by Finlayson et al and others support the notion that operative mortality is higher in low-volume hospitals. However, several questions remain: What factors are responsible for the higher mortality? Is it because of poor patient selection, more comorbidities, or inferior perioperative treatment at low-volume hospitals? Is it because patients with tumors that have a better prognosis select higher-volume hospitals? Are the surgical skills of practioners at high-volume hospitals significantly superior to those at low-volume hospitals? Are those skills transferable, or should patients with certain malignancies be transferred to high-volume units? Finally, how do we define volume? Does a low-volume surgeon at a high-volume hospital have better results than this surgeon's counterpart practicing in a low-volume hospital?
Davies RJ. Hospital Volume and Operative Mortality in Cancer Surgery—Invited Critique. Arch Surg. 2003;138(7):726. doi:10.1001/archsurg.138.7.726