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July 28, 1989

Surgeon Volume vs Hospital Volume: Which Matters More?

JAMA. 1989;262(4):547-548. doi:10.1001/jama.1989.03430040119038

Hannan and colleagues1 report that patients undergoing coronary artery bypass graft surgery, repair of abdominal aortic aneurysm, partial gastrectomy, or colectomy in hospitals in New York State had significantly lower in-hospital mortality rates when they were operated on by physicians who had done a higher number of surgeries during the preceding 12 months. For cholecystectomy, patients operated on in high-volume hospitals had better outcomes than patients in lower-volume hospitals.

Of the five other studies2-6 of the relationship between physician volume and outcome published in the literature to date, this is the first to measure each physician's volume of surgery in all hospitals and to link that volume to each patient's outcome. The results provide strong evidence to support our intuition that higher surgeon volume as well as, or in some cases instead of, higher hospital volume is associated with better outcomes. A better understanding of the role of