Improving the quality of surgical care is an important priority. To this end, the study by Billingsley et al provides important information to enhance our understanding of factors associated with surgical quality. They found that another structural variable, the presence of sophisticated clinical services, was the most important explanatory variable linking hospital volume and mortality. The authors have provided an important start in discovering the “secrets” of high-volume hospitals. This is similar to coronary bypass quality improvement findings, where having a dedicated cardiac intensive care unit and intensive care unit team have been associated with better outcomes. However, as they also admit, efforts should be made to identify the key processes of care that the high-quality hospitals are performing so that all hospitals, high and low volume, may perform them. While many will agree with this sentiment, identifying and then measuring such processes may not be so easy.
Ko C, McGory M. Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer Surgery—Invited Critique. Arch Surg. 2007;142(1):32. doi:10.1001/archsurg.142.1.32