The Volume-Outcomes Relationship in Surgery: So Much Research, So Few Answers

The relationship between surgical volume and patient outcomes has been studied extensively since the 1980s. The “volume” variable is often measured in two ways: hospital volume (the amount of surgeries the hospital performs) and surgeon volume (the amount of surgeries each surgeon performs). So, do high-volume hospitals and providers achieve better outcomes? Luft and colleagues first presented this theory in 1980 and proposed that a positive relationship existed between the two variables even after adjusting for hospital variables such as size, teaching status and geographic location.¹  Since then, hundreds of studies have been published on the topic examining various surgical procedures as well as nonsurgical care such as trauma, critical care and cancer care. To summarize the existing literature about the relationship between hospital volume and patient outcomes in surgery, Pieper et al. recently conducted a systematic review...