"Those hospitals that do a high volume of complex procedures have all sorts of special resources to handle complicated medical problems," says David Urbach, a professor in the Departments of Surgery and Health, Policy, Management and Evaluation, a surgeon at Toronto General Hospital and an adjunct scientist for the Institute for Clinical Evaluative Sciences. "The human resources and technical resources at these hospitals are different than at smaller ones."
Urbach analysed the outcomes of five complex surgical procedures - removal of the esophagus, colorectal resection for cancer, pancreatico-duodenectomy (removing the head of the pancreas and a portion of the small intestine), major lung resection and repair of an unruptured aortal aneurysm - conducted in Ontario hospitals between 1994 and 1999. He found that the more often any of the five surgical procedures was done at a hospital, the lower the morality rate from most of them. The results of his findings appeared in the March 27 issue of the British Medical Journal.
The results of the study offer an opportunity for health policy-makers to reconsider regionalization of procedures and allocation of services, says Urbach. "We need to think of ways to even out services so we can preserve quality of care at smaller facilities."