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(Circulation. 2007;115:2599-2601.)
© 2007 American Heart Association, Inc.

Editorial

Reevaluation of the Volume-Outcome Relationship for Pediatric Cardiac Surgery

Kimberlee Gauvreau, ScD

From the Department of Cardiology, Children’s Hospital; Department of Pediatrics, Harvard Medical School; and Department of Biostatistics, Harvard School of Public Health, Boston, Mass.

Correspondence to Kimberlee Gauvreau, ScD, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail gauvreau@tch.harvard.edu

Key Words: Editorials • heart surgery, congenital • hospitals

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Over the last 3 decades, a growing body of work has demonstrated a relationship between volume and outcome for a variety of complex surgical procedures and medical conditions. Two large-scale reviews have systemically evaluated the methodology and results of many of these studies across a broad range of conditions.^1,2 In 2000, Dudley et al¹ found that, among 128 studies examining 40 different procedures or conditions, 80% reported a statistically significant relationship between higher institutional case volume and better clinical outcomes; none of the published studies reported an association between higher volume and worse outcomes. In 2002, Halm et al² evaluated 135 studies for 27 procedures or conditions, many of which were included in the previous review; a preliminary version of this report served as the focus of an Institute of Medicine workshop examining the volume-outcome relationship in the context of healthcare quality.³ The authors concluded that 70% of comparisons examining either institutional or physician case volume noted a statistically significant relationship between higher volume and better outcomes. Once again, none of the reports found the opposite to be true.

Article p 2652

Pediatric cardiac surgery is the only surgical procedure performed in children for which a volume-outcome relationship has been documented. In 4 large studies conducted in the United States (2 studies^4,5 included in the review by Dudley et al,¹ 3 studies^4–6 in the Halm et al² review, and 1 study⁷ published subsequent to these reviews), larger annual surgical case volumes were associated with substantial reductions in in-hospital mortality. These . . . [Full Text of this Article]

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Circulation 2007 115: 2591. [Extract] [Full Text]