Is bigger better?

A major impetus for the regionalization of complex surgical procedures at high-volume hospitals is the belief that many postoperative deaths would be prevented if more people had their surgery at such large institutions. However, a new study by David Urbach shows that no benefit would accrue from regionalizing resection of the colon or rectum for cancer at high-volume hospitals in Ontario.

Urbach and colleagues tested the hypothesis that patients undergoing complex procedures fare better at hospitals that perform such procedures frequently by collecting data concerning 31 632 people who underwent 1 of 5 different surgical procedures. The authors compared the results of these procedures (2 with high and 3 with low operative mortality) at Ontario hospitals with higher and lower operative frequency.

"There may be good reasons for volume-based regionalization of certain complex surgical procedures," state the authors. "However, the perception that the main benefit of regionalization is a substantial reduction in postoperative mortality may be erroneous."

------ p. 1409 Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization -- D.R Urbach et al

---

---