FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 349:2117-2127 November 27, 2003 Number 22 Next

	Full Text PDF PDA Full Text Supplementary Material Editorial by Kizer, K. W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain.

Methods Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers.

Results Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The adjusted odds ratio for operative death (for patients with a low-volume surgeon vs. those with a high-volume surgeon) varied widely according to the procedure — from 1.24 for lung resection to 3.61 for pancreatic resection. Surgeon volume accounted for a large proportion of the apparent effect of the hospital volume, to an extent that varied according to the procedure: it accounted for 100 percent of the effect for aortic-valve replacement, 57 percent for elective repair of an abdominal aortic aneurysm, 55 percent for pancreatic resection, 49 percent for coronary-artery bypass grafting, 46 percent for esophagectomy, 39 percent for cystectomy, and 24 percent for lung resection. For most procedures, the mortality rate was higher among patients of low-volume surgeons than among those of high-volume surgeons, regardless of the surgical volume of the hospital in which they practiced.

Conclusions For many procedures, the observed associations between hospital volume and operative mortality are largely mediated by surgeon volume. Patients can often improve their chances of survival substantially, even at high-volume hospitals, by selecting surgeons who perform the operations frequently.

Source Information

From the Department of Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, N.H. (J.D.B., P.P.G.); the Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vt. (J.D.B., P.P.G.); the Institute for Clinical Evaluative Sciences, Toronto (T.A.S.); and the Center for Outcomes Research and Evaluation, Maine Medical Center, Portland (A.E.S., D.E.W., F.L.L.).

Address reprint requests to Dr. Birkmeyer at the Section of General Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756, or at john.birkmeyer{at}hitchcock.org.

Full Text of this Article

Related Letters:

Surgeon Volume and Operative Mortality
Gutow A. P., Erlebacher J. A., Hubbard S. G., Birkmeyer J. D., Kizer K. W.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:1256-1258, Mar 18, 2004. Correspondence

This article has been cited by other articles:

• Brunelli, A., Charloux, A., Bolliger, C. T., Rocco, G., Sculier, J-P., Varela, G., Licker, M., Ferguson, M. K., Faivre-Finn, C., Huber, R. M., Clini, E. M., Win, T., De Ruysscher, D., Goldman, L., on behalf of the European Respiratory Society and, (2009). ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 34: 17-41 [Abstract] [Full Text]  
• Kapadia, S. R., Goel, S. S., Svensson, L., Roselli, E., Savage, R. M., Wallace, L., Sola, S., Schoenhagen, P., Shishehbor, M. H., Christofferson, R., Halley, C., Rodriguez, L. L., Stewart, W., Kalahasti, V., Tuzcu, E. M. (2009). Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement.. J. Thorac. Cardiovasc. Surg. 137: 1430-1435 [Abstract] [Full Text]  
• Auerbach, A. D., Hilton, J. F., Maselli, J., Pekow, P. S., Rothberg, M. B., Lindenauer, P. K. (2009). Shop for Quality or Volume? Volume, Quality, and Outcomes of Coronary Artery Bypass Surgery. ANN INTERN MED 150: 696-704 [Abstract] [Full Text]  
• Yap, C.-H., Andrianopoulos, N., Dinh, D. T., Billah, B., Rosalion, A., Smith, J. A., Shardey, G. C., Skillington, P. D., Tatoulis, J., Mohajeri, M., Yii, M., Reid, C. M. (2009). Short- and midterm outcomes of coronary artery bypass surgery performed by surgeons in training.. J. Thorac. Cardiovasc. Surg. 137: 1088-1092 [Abstract] [Full Text]  
• Gruen, R. L., Pitt, V., Green, S., Parkhill, A., Campbell, D., Jolley, D. (2009). The Effect of Provider Case Volume on Cancer Mortality: Systematic Review and Meta-Analysis. CA Cancer J Clin 59: 192-211 [Abstract] [Full Text]  
• Kronebusch, K. (2009). Assessing Changes in High-Volume Hospital Use: Hospitals, Payers, and Aggregate Volume Trends. Med Care Res Rev 66: 197-218 [Abstract]  
• Hirsch, J. C., Birkmeyer, J. D. (2008). Growing Pains: The Challenges of Managing Congenital Heart Disease After Childhood. Circulation 118: 2321-2322 [Full Text]  
• Young, A. S., Niv, N., Cohen, A. N., Kessler, C., McNagny, K. (2008). The Appropriateness of Routine Medication Treatment for Schizophrenia. Schizophr Bull 0: sbn138v1-sbn138 [Abstract] [Full Text]  
• Kozower, B. D., Stukenborg, G. J., Lau, C. L., Jones, D. R. (2008). Measuring the Quality of Surgical Outcomes in General Thoracic Surgery: Should Surgical Volume Be Used to Direct Patient Referrals?. Ann. Thorac. Surg. 86: 1405-1408 [Full Text]  
• Falconi, M., Crippa, S., Dominguez, I., Barugola, G., Capelli, P., Marcucci, S., Beghelli, S., Scarpa, A., Bassi, C., Pederzoli, P. (2008). Prognostic Relevance of Lymph Node Ratio and Number of Resected Nodes after Curative Resection of Ampulla of Vater Carcinoma. Ann. Surg. Oncol. 15: 3178-3186 [Abstract] [Full Text]  
• Weiss, E. S., Meguid, R. A., Patel, N. D., Russell, S. D., Shah, A. S., Baumgartner, W. A., Conte, J. V. (2008). Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change?. Ann. Thorac. Surg. 86: 1250-1260 [Abstract] [Full Text]  
• Schneider, J. E., Miller, T. R., Ohsfeldt, R. L., Morrisey, M. A., Zelner, B. A., Pengxiang Li, (2008). The Economics of Specialty Hospitals. Med Care Res Rev 65: 531-553 [Abstract]  
• Bilimoria, K. Y., Bentrem, D. J., Feinglass, J. M., Stewart, A. K., Winchester, D. P., Talamonti, M. S., Ko, C. Y. (2008). Directing Surgical Quality Improvement Initiatives: Comparison of Perioperative Mortality and Long-Term Survival for Cancer Surgery. JCO 26: 4626-4633 [Abstract] [Full Text]  
• Wong, S. L., McCahill, L. E., Edge, S. B., Askew, R. L., Beitsch, P. D., Kollmorgen, D. R., Anthony, T., Petrelli, N. J., Leong, S. P. L., Cormier, J. N. (2008). Getting to Better Cancer Care: Results of a Society of Surgical Oncology Survey. Ann. Surg. Oncol. 15: 2363-2371 [Abstract] [Full Text]  
• Rutegard, M., Lagergren, P. (2008). No Influence of Surgical Volume on Patients' Health-Related Quality of Life After Esophageal Cancer Resection. Ann. Surg. Oncol. 15: 2380-2387 [Abstract] [Full Text]  
• Pech, O, Behrens, A, May, A, Nachbar, L, Gossner, L, Rabenstein, T, Manner, H, Guenter, E, Huijsmans, J, Vieth, M, Stolte, M, Ell, C (2008). Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus. Gut 57: 1200-1206 [Abstract] [Full Text]  
• Schelbert, E B, Vaughan-Sarrazin, M S, Welke, K F, Rosenthal, G E (2008). Valve type and long-term outcomes after aortic valve replacement in older patients. Heart 94: 1181-1188 [Abstract] [Full Text]  
• Farjah, F., Wood, D. E., Varghese, T. K. Jr, Symons, R. G., Flum, D. R. (2008). Trends in the Operative Management and Outcomes of T4 Lung Cancer. Ann. Thorac. Surg. 86: 368-374 [Abstract] [Full Text]  
• Zatzick, D. F., Jurkovich, G. J., Fan, M.-Y., Grossman, D., Russo, J., Katon, W., Rivara, F. P. (2008). Association Between Posttraumatic Stress and Depressive Symptoms and Functional Outcomes in Adolescents Followed Up Longitudinally After Injury Hospitalization. Arch Pediatr Adolesc Med 162: 642-648 [Abstract] [Full Text]  
• Sheinfeld, J., Motzer, R. J. (2008). Stage I Testicular Cancer Management and Necessity for Surgical Expertise. JCO 26: 2934-2936 [Full Text]  
• Rhodes, R. S. (2008). Grabo DJ, DiMuzio PJ, Kairys JC, McIlhenny SE, Crawford AG, Yeo CJ. Have endovascular procedures negatively impacted general surgery training? Ann Surg. 2007;246:472-480. PERSPECT VASC SURG ENDOVASC THER 20: 227-228  
• Farjah, F., Wood, D. E., Yanez, D. III, Symons, R. G., Krishnadasan, B., Flum, D. R. (2008). Temporal Trends in the Management of Potentially Resectable Lung Cancer. Ann. Thorac. Surg. 85: 1850-1856 [Abstract] [Full Text]  
• Carey, J. S., Parker, J. P., Brandeau, C., Li, Z. (2008). The "occasional open heart surgeon" revisited.. J. Thorac. Cardiovasc. Surg. 135: 1254-1260 [Abstract] [Full Text]  
• Dimick, J. B., Upchurch, G. R. Jr (2008). Measuring and Improving the Quality of Care for Abdominal Aortic Aneurysm Surgery. Circulation 117: 2534-2541 [Full Text]  
• Meek, R.M.D, Allan, D.B., McPhillips, G., Kerr, L., Howie, C.R., From the Scottish Arthroplasty Project, (2008). Late Dislocation after Total Hip Arthroplasty. Clin Med Res 6: 17-23 [Abstract] [Full Text]  
• Zahn, R, Gottwik, M, Hochadel, M, Senges, J, Zeymer, U, Vogt, A, Meinertz, T, Dietz, R, Hauptmann, K E, Grube, E, Kerber, S, Sechtem, U (2008). Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Heart 94: 329-335 [Abstract] [Full Text]  
• Boutron, I., Moher, D., Altman, D. G., Schulz, K. F., Ravaud, P., for the CONSORT Group, (2008). Extending the CONSORT Statement to Randomized Trials of Nonpharmacologic Treatment: Explanation and Elaboration. ANN INTERN MED 148: 295-309 [Abstract] [Full Text]  
• Rivard, P. E., Luther, S. L., Christiansen, C. L., Shibei Zhao, , Loveland, S., Elixhauser, A., Romano, P. S., Rosen, A. K. (2008). Using Patient Safety Indicators to Estimate the Impact of Potential Adverse Events on Outcomes. Med Care Res Rev 65: 67-87 [Abstract]  
• Chang, A. C., Ji, H., Birkmeyer, N. J., Orringer, M. B., Birkmeyer, J. D. (2008). Outcomes After Transhiatal and Transthoracic Esophagectomy for Cancer. Ann. Thorac. Surg. 85: 424-429 [Abstract] [Full Text]  
• Boffa, D. J., Allen, M. S., Grab, J. D., Gaissert, H. A., Harpole, D. H., Wright, C. D. (2008). Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors.. J. Thorac. Cardiovasc. Surg. 135: 247-254 [Abstract] [Full Text]  
• Brown, M. L., Pellikka, P. A., Schaff, H. V., Scott, C. G., Mullany, C. J., Sundt, T. M., Dearani, J. A., Daly, R. C., Orszulak, T. A. (2008). The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis.. J. Thorac. Cardiovasc. Surg. 135: 308-315 [Abstract] [Full Text]  
• Michalski, C. W., Kleeff, J., Bachmann, J., AlKhatib, J., Erkan, M., Esposito, I., Hinz, U., Friess, H., Buchler, M. W. (2008). Second-Look Operation for Unresectable Pancreatic Ductal Adenocarcinoma at a High-Volume Center. Ann. Surg. Oncol. 15: 186-192 [Abstract] [Full Text]  
• Pech, O., May, A., Rabenstein, T., Ell, C. (2007). Endoscopic resection of early oesophageal cancer. Gut 56: 1625-1634 [Full Text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Buller, C. E., Creager, M. A., Ettinger, S. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., Tarkington, L. G., Yancy, C. W. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 50: e159-e242 [Full Text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: e418-e500 [Full Text]  
• Nattinger, A. B., Laud, P. W., Sparapani, R. A., Zhang, X., Neuner, J. M., Gilligan, M. A. (2007). Exploring the Surgeon Volume Outcome Relationship Among Women With Breast Cancer. Arch Intern Med 167: 1958-1963 [Abstract] [Full Text]  
• Markman, M. (2007). Concept of Optimal Surgical Cytoreduction in Advanced Ovarian Cancer: A Brief Critique and a Call for Action. JCO 25: 4168-4170 [Full Text]  
• Hollenbeck, B. K., Hong Ji, , Zaojun Ye, , Birkmeyer, J. D. (2007). Misclassification of Hospital Volume With Surveillance, Epidemiology, and End Results Medicare Data. SURG INNOV 14: 192-198 [Abstract]  
• Rodgers, M., Jobe, B. A., O'Rourke, R. W., Sheppard, B., Diggs, B., Hunter, J. G. (2007). Case Volume as a Predictor of Inpatient Mortality After Esophagectomy. Arch Surg 142: 829-839 [Abstract] [Full Text]  
• Colice, G. L., Shafazand, S., Griffin, J. P., Keenan, R., Bolliger, C. T. (2007). Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest 132: 161S-177S [Abstract] [Full Text]  
• Sundaresan, S., Langer, B., Oliver, T., Schwartz, F., Brouwers, M., Stern, H., Expert Panel on Thoracic Surgical Oncology, (2007). Standards for Thoracic Surgical Oncology in a Single-Payer Healthcare System. Ann. Thorac. Surg. 84: 693-701 [Abstract] [Full Text]  
• Cram, P., Vaughan-Sarrazin, M. S., Wolf, B., Katz, J. N., Rosenthal, G. E. (2007). A Comparison of Total Hip and Knee Replacement in Specialty and General Hospitals. JBJS 89: 1675-1684 [Abstract] [Full Text]  
• Glance, L. G., Osler, T. M., Mukamel, D. B., Dick, A. W. (2007). Estimating the potential impact of regionalizing health care delivery based on volume standards versus risk-adjusted mortality rate. Int J Qual Health Care 19: 195-202 [Abstract] [Full Text]  
• Vickers, A. J., Bianco, F. J., Serio, A. M., Eastham, J. A., Schrag, D., Klein, E. A., Reuther, A. M., Kattan, M. W., Pontes, J. E., Scardino, P. T. (2007). The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy. JNCI J Natl Cancer Inst 99: 1171-1177 [Abstract] [Full Text]  
• Tanner, S. (2007). Trends in children's surgery in England. Arch. Dis. Child. 92: 664-667 [Full Text]  
• McCabe, J. E, Jibawi, A., Javle, P. M (2007). Radical cystectomy: defining the threshold for a surgeon to achieve optimum outcomes. Postgrad. Med. J. 83: 556-560 [Abstract] [Full Text]  
• Fujitani, K., Ajani, J. A., Crane, C. H., Feig, B. W., Pisters, P. W., Janjan, N., Walsh, G. L., Swisher, S. G., Vaporciyan, A. A., Rice, D., Welch, A., Baker, J., Faust, J., Mansfield, P. F. (2007). Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction. Ann. Surg. Oncol. 14: 2010-2017 [Abstract] [Full Text]  
• Turchin, A., Shubina, M., Pendergrass, M. L. (2007). Relationship of Physician Volume With Process Measures and Outcomes in Diabetes. Diabetes Care 30: 1442-1447 [Abstract] [Full Text]  
• Verhoef, C., van de Weyer, R., Schaapveld, M., Bastiaannet, E., Plukker, J. Th. M. (2007). Better Survival in Patients with Esophageal Cancer After Surgical Treatment in University Hospitals: A Plea for Performance by Surgical Oncologists. Ann. Surg. Oncol. 14: 1678-1687 [Abstract] [Full Text]  
• Fujitani, K., Ajani, J. A., Crane, C. H., Feig, B. W., Pisters, P. W., Janjan, N., Walsh, G. L., Swisher, S. G., Vaporciyan, A. A., Rice, D., Welch, A., Baker, J., Faust, J., Mansfield, P. F. (2007). Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction. Ann. Surg. Oncol. 14: 1305-1311 [Abstract] [Full Text]  
• Vermeulen, M. J., Schull, M. J. (2007). Missed Diagnosis of Subarachnoid Hemorrhage in the Emergency Department. Stroke 38: 1216-1221 [Abstract] [Full Text]  
• van Meerbeeck, J. P., Kramer, G. W. P. M., Van Schil, P. E. Y., Legrand, C., Smit, E. F., Schramel, F., Tjan-Heijnen, V. C., Biesma, B., Debruyne, C., van Zandwijk, N., Splinter, T. A. W., Giaccone, G. (2007). Randomized Controlled Trial of Resection Versus Radiotherapy After Induction Chemotherapy in Stage IIIA-N2 Non-Small-Cell Lung Cancer. JNCI J Natl Cancer Inst 99: 442-450 [Abstract] [Full Text]  
• Porter, M. E., Teisberg, E. O. (2007). How Physicians Can Change the Future of Health Care. JAMA 297: 1103-1111 [Abstract] [Full Text]  
• Weber, W. P., Guller, U., Jain, N. B., Pietrobon, R., Oertli, D. (2007). Impact of Surgeon and Hospital Caseload on the Likelihood of Performing Laparoscopic vs Open Sigmoid Resection for Diverticular Disease: A Study Based on 55 949 Patients. Arch Surg 142: 253-259 [Abstract] [Full Text]  
• Gammie, J. S., O'Brien, S. M., Griffith, B. P., Ferguson, T. B., Peterson, E. D. (2007). Influence of Hospital Procedural Volume on Care Process and Mortality for Patients Undergoing Elective Surgery for Mitral Regurgitation. Circulation 115: 881-887 [Abstract] [Full Text]  
• Rouvelas, I., Lindblad, M., Zeng, W., Viklund, P., Ye, W., Lagergren, J. (2007). Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery. Arch Surg 142: 113-117 [Abstract] [Full Text]  
• Kahn, K. L. (2007). On Referral Patterns for Patients With Breast Cancer. JCO 25: 244-246 [Full Text]  
• Katz, S. J., Hofer, T. P., Hawley, S., Lantz, P. M., Janz, N. K., Schwartz, K., Liu, L., Deapen, D., Morrow, M. (2007). Patterns and Correlates of Patient Referral to Surgeons for Treatment of Breast Cancer. JCO 25: 271-276 [Abstract] [Full Text]  
• Berry, J. G., Lieu, T. A., Forbes, P. W., Goldmann, D. A. (2007). Hospital Volumes for Common Pediatric Specialty Operations. Arch Pediatr Adolesc Med 161: 38-43 [Abstract] [Full Text]  
• Billingsley, K. G., Morris, A. M., Dominitz, J. A., Matthews, B., Dobie, S., Barlow, W., Wright, G. E., Baldwin, L.-M. (2007). Surgeon and Hospital Characteristics as Predictors of Major Adverse Outcomes Following Colon Cancer Surgery: Understanding the Volume-Outcome Relationship. Arch Surg 142: 23-31 [Abstract] [Full Text]  
• Parekh, D. J., Bochner, B. H., Dalbagni, G. (2006). Superficial and Muscle-Invasive Bladder Cancer: Principles of Management for Outcomes Assessments. JCO 24: 5519-5527 [Abstract] [Full Text]  
• Tien, H. C., Farrell, R., Macdonald, J. (2006). Preparing Canadian military surgeons for Afghanistan.. CMAJ 175: 1365-1365 [Full Text]  
• DiSesa, V. J., O'Brien, S. M., Welke, K. F., Beland, S. M., Haan, C. K., Vaughan-Sarrazin, M. S., Peterson, E. D. (2006). Contemporary Impact of State Certificate-of-Need Regulations for Cardiac Surgery: An Analysis Using the Society of Thoracic Surgeons' National Cardiac Surgery Database. Circulation 114: 2122-2129 [Abstract] [Full Text]  
• Liu, J. H., Zingmond, D. S., McGory, M. L., SooHoo, N. F., Ettner, S. L., Brook, R. H., Ko, C. Y. (2006). Disparities in the utilization of high-volume hospitals for complex surgery.. JAMA 296: 1973-1980 [Abstract] [Full Text]  
• Khan, K., Campbell, A., Wallington, T., Gardam, M. (2006). The impact of physician training and experience on the survival of patients with active tuberculosis.. CMAJ 175: 749-753 [Abstract] [Full Text]  
• Steyerberg, E. W., Neville, B. A., Koppert, L. B., Lemmens, V. E.P.P., Tilanus, H. W., Coebergh, J.-W. W., Weeks, J. C., Earle, C. C. (2006). Surgical Mortality in Patients With Esophageal Cancer: Development and Validation of a Simple Risk Score. JCO 24: 4277-4284 [Abstract] [Full Text]  
• Teufelsbauer, H., Polterauer, P., Lammer, J., Huk, I., Nanobachvili, J., Kretschmer, G. (2006). Repair of Abdominal Aortic Aneurysms: The Benefits of Offering Both Endovascular and Open Surgical Techniques. PERSPECT VASC SURG ENDOVASC THER 18: 238-246 [Abstract]  
• Parekh, D. (2006). Laparoscopic-Assisted Pancreatic Necrosectomy: A New Surgical Option for Treatment of Severe Necrotizing Pancreatitis. Arch Surg 141: 895-903 [Abstract] [Full Text]  
• Shishehbor, M. H., Litaker, D., Lauer, M. S. (2006). Mediators of the Association Between Mortality Risk and Socioeconomic Status--Reply. JAMA 296: 764-764 [Full Text]  
• Brotman, D. J. (2006). Mediators of the association between mortality risk and socioeconomic status.. JAMA 296: 763-764 [Full Text]  
• Roffi, M., Yadav, J. S. (2006). Carotid Stenting. Circulation 114: e1-e4 [Full Text]  
• Ho, V., Heslin, M. J., Yun, H., Howard, L. (2006). Trends in Hospital and Surgeon Volume and Operative Mortality for Cancer Surgery. Ann. Surg. Oncol. 13: 851-858 [Abstract] [Full Text]  
• Judge, A., Chard, J., Learmonth, I., Dieppe, P. (2006). The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England. J Public Health (Oxf) 28: 116-124 [Abstract] [Full Text]  
• Konety, B. R., Allareddy, V., Modak, S., Smith, B. (2006). Mortality After Major Surgery for Urologic Cancers in Specialized Urology Hospitals: Are They Any Better?. JCO 24: 2006-2012 [Abstract] [Full Text]  
• Feudtner, C., Silveira, M. J., Shabbout, M., Hoskins, R. E. (2006). Distance From Home When Death Occurs: A Population-Based Study of Washington State, 1989-2002. Pediatrics 117: e932-e939 [Abstract] [Full Text]  
• Ferri, L. E., Law, S., Wong, K.-H., Kwok, K.-F., Wong, J. (2006). The Influence of Technical Complications on Postoperative Outcome and Survival After Esophagectomy. Ann. Surg. Oncol. 13: 557-564 [Abstract] [Full Text]  
• David, T. E. (2006). Should cardiac surgery be performed in low-volume hospitals?. J. Thorac. Cardiovasc. Surg. 131: 773-774 [Full Text]  
• Francis, D. O., Beckman, H., Chamberlain, J., Partridge, G., Greene, R. A. (2006). Introducing a Multifaceted Intervention to Improve the Management of Otitis Media: How Do Pediatricians, Internists, and Family Physicians Respond?. American Journal of Medical Quality 21: 134-143 [Abstract]  
• Birkmeyer, N. J.O., Birkmeyer, J. D. (2006). Strategies for improving surgical quality--should payers reward excellence or effort?. NEJM 354: 864-870 [Full Text]  
• Shishehbor, M. H., Litaker, D., Pothier, C. E., Lauer, M. S. (2006). Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality. JAMA 295: 784-792 [Abstract] [Full Text]  
• Lipscomb, J. (2006). Transcending the Volume-Outcome Relationship in Cancer Care. JNCI J Natl Cancer Inst 98: 151-154 [Full Text]  
• Schrag, D., Earle, C., Xu, F., Panageas, K. S., Yabroff, K. R., Bristow, R. E., Trimble, E. L., Warren, J. L. (2006). Associations Between Hospital and Surgeon Procedure Volumes and Patient Outcomes After Ovarian Cancer Resection. JNCI J Natl Cancer Inst 98: 163-171 [Abstract] [Full Text]  
• Trivedi, A. N., Sequist, T. D., Ayanian, J. Z. (2006). Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality. J Am Coll Cardiol 47: 417-424 [Abstract] [Full Text]  
• Nallamothu, B. K., Wang, Y., Magid, D. J., McNamara, R. L., Herrin, J., Bradley, E. H., Bates, E. R., Pollack, C. V. Jr, Krumholz, H. M., for the National Registry of Myocardial Infarction, (2006). Relation Between Hospital Specialization With Primary Percutaneous Coronary Intervention and Clinical Outcomes in ST-Segment Elevation Myocardial Infarction: National Registry of Myocardial Infarction-4 Analysis. Circulation 113: 222-229 [Abstract] [Full Text]  
• Freixinet, J. L., Julia-Serda, G., Rodriguez, P. M., Santana, N. B., de Castro, F. R., Fiuza, M. D., Lopez-Encuentra, A., Bronchogenic Carcinoma Cooperative Group of the Sp, (2006). Hospital volume: operative morbidity, mortality and survival in thoracotomy for lung cancer.: A Spanish multicenter study of 2994 cases. Eur. J. Cardiothorac. Surg. 29: 20-25 [Abstract] [Full Text]  
• Babikian, V. L., Wolf, P. A. (2005). Retinal and Cerebral Microembolism During On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery. Circulation 112: 3816-3817 [Full Text]  
• Welke, K. F., Barnett, M. J., Vaughan Sarrazin, M. S., Rosenthal, G. E. (2005). Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery. Ann. Thorac. Surg. 80: 2114-2119 [Abstract] [Full Text]  
• Vitale, M. A., Heyworth, B. E., Skaggs, D. L., Roye, D. P. Jr., Lipton, C. B., Vitale, M. G. (2005). Comparison of the Volume of Scoliosis Surgery Between Spine and Pediatric Orthopaedic Fellowship-Trained Surgeons in New York and California. JBJS 87: 2687-2692 [Abstract] [Full Text]  
• Ly, D. P., Liao, J. G., Burd, R. S. (2005). Effect of Surgeon and Hospital Characteristics on Outcome After Pyloromyotomy. Arch Surg 140: 1191-1197 [Abstract] [Full Text]  
• Bellomo, R., Egi, M. (2005). Glycemic Control in the Intensive Care Unit: Why We Should Wait for NICE-SUGAR. Mayo Clin Proc. 80: 1546-1548  
• Nallamothu, B. K., Eagle, K. A., Ferraris, V. A., Sade, R. M. (2005). Should Coronary Artery Bypass Grafting Be Regionalized?. Ann. Thorac. Surg. 80: 1572-1581 [Full Text]  
• Michelet, P., D'Journo, X.-B., Roch, A., Papazian, L., Ragni, J., Thomas, P., Auffray, J.-P. (2005). Perioperative Risk Factors for Anastomotic Leakage After Esophagectomy: Influence of Thoracic Epidural Analgesia. Chest 128: 3461-3466 [Abstract] [Full Text]  
• Flum, D. R., Salem, L., Broeckel Elrod, J. A., Dellinger, E. P., Cheadle, A., Chan, L. (2005). Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures. JAMA 294: 1903-1908 [Abstract] [Full Text]  
• Al-Khatib, S. M., Lucas, F. L., Jollis, J. G., Malenka, D. J., Wennberg, D. E. (2005). The Relation Between Patients' Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries. J Am Coll Cardiol 46: 1536-1540 [Abstract] [Full Text]  
• Schelbert, E. B., Rosenthal, G. E., Welke, K. F., Vaughan-Sarrazin, M. S. (2005). Treatment Variation in Older Black and White Patients Undergoing Aortic Valve Replacement. Circulation 112: 2347-2353 [Abstract] [Full Text]  
• David, T. E. (2005). For everything there is a season. J. Thorac. Cardiovasc. Surg. 130: 961-965 [Full Text]