Finks, J.F., Osborne, N.H., & Birkmeyer, J.D. (2011). Trends in hospital volume and operative mortality for high-risk surgery. The New England Journal of Medicine: Health Policy and Reform. Retrieved from http://healthpolicyandreform.nejm.org/?p=14613&query=home.

“Fueled by a growing number of studies reporting inverse relationships between hospital volume and surgical mortality, there was considerable interest in the United States during the previous decade in concentrating selected operations in high-volume hospitals. The Leapfrog Group, a consortium of large corporations and public agencies that purchase health care, has been among the most prominent advocates of volume-based referral. In 2000, it established minimum volume standards for several surgical procedures as part of a broader, value-based purchasing initiative. Private payers and professional organizations in the United States have also established minimum volume standards as part of Centers of Excellence accreditation programs for a variety of operations.

Whether such efforts have altered referral patterns for high-risk surgery remains uncertain, however. There are still many barriers to regionalization, including patient preferences for local care, financial incentives for smaller hospitals to retain surgical cases and lack of access to high-volume centers in some regions. Despite increasing numbers of surgical patients in high-volume hospitals, the net effects on operative mortality are difficult to predict. Although hospital volume of a few high-risk cancer procedures (e.g., pancreatectomy) is a strong predictor of operative risk, relationships between volume and outcome are considerably weaker for most operations.

In this study, we used data from national Medicare claims to evaluate trends in the use of high-volume hospitals for major cancer resections and cardiovascular surgery. We also examined concurrent trends in operative mortality rates associated with these procedures and the extent to which decreases in mortality could be associated with a concentration of surgical care in high-volume hospitals.”