Special Article
The Influence of Hospital Volume on Survival after Resection for Lung Cancer
N Engl J Med 2001; 345:181-188July 19, 2001
- Abstract
Background
Among patients who have undergone high-risk operations for cancer, postoperative mortality rates are often lower at hospitals where more of these procedures are performed. We undertook a population-based study to estimate the extent to which the number of procedures performed at a hospital (hospital volume) is associated with survival after resection for lung cancer.
Methods
We studied patients 65 years old or older who received a diagnosis of stage I, II, or IIIA non–small-cell lung cancer between 1985 and 1996, resided in 1 of the 10 study areas covered by the Surveillance, Epidemiology, and End Results Program, and underwent surgery at a hospital that participates in the Nationwide Inpatient Sample (2118 patients and 76 hospitals).
Results
The volume of procedures at the hospital was positively associated with the survival of patients (P<0.001). Five years after surgery, 44 percent of patients who underwent operations at the hospitals with the highest volume were alive, as compared with 33 percent of those who underwent operations at the hospitals with the lowest volume. Patients at the highest-volume hospitals also had lower rates of postoperative complications (20 percent vs. 44 percent) and lower 30-day mortality (3 percent vs. 6 percent) than those at the lowest-volume hospitals.
Conclusions
Patients who undergo resection for lung cancer at hospitals that perform large numbers of such procedures are likely to survive longer than patients who have such surgery at hospitals with a low volume of lung-resection procedures.
Media in This Article
Figure 1
Survival of Medicare Beneficiaries 65 Years of Age or Older Who Received a Diagnosis of Stage I, II, or IIIA Non–Small-Cell Lung Cancer between 1985 and 1996 and Underwent Resection for Lung Cancer, According to the Volume of Such Procedures Performed Annually at the Hospitals Where the Patients Were Treated.Table 1
Characteristics of the Patients Identified through the SEER–Medicare Data Base and of the Hospitals Identified from the Nationwide Inpatient Sample That Were Included in or Excluded from the Study.Article Activity
- Article
An association between the number of operations for cancer performed at a hospital (hospital volume) and the outcome of those operations has been shown for esophagectomy and pancreatectomy,1-3 as well as for operations for breast cancer, colon cancer, and prostate cancer.4-11 There is, however, incomplete evidence concerning this association in the case of surgery for lung cancer. Neither Khuri and colleagues12 nor Begg et al.1 (who focused exclusively on pneumectomy) found a significant trend toward lower 30-day mortality at hospitals with high volumes of lung-cancer operations. Romano and Mark, however, found that in-hospital mortality rates were significantly lower after resections for lung cancer at hospitals with high volumes of the procedure.13
In this study of the relation between hospital volume and outcome after surgery for lung cancer, we examined the rates of survival and postoperative complications in both teaching and nonteaching hospitals.14,15
Methods
Sources of Data
The Surveillance, Epidemiology, and End Results Program and Medicare
Patients were identified from the Surveillance, Epidemiology, and Ends Results (SEER) Cancer Registries, which have been linked to data on Medicare hospitalizations. The SEER data base contains detailed information on all newly diagnosed cases of cancer in five metropolitan areas (San Francisco, Oakland, and San Jose, California; Detroit; Atlanta; Seattle; and Los Angeles County) and five states (Connecticut, Utah, New Mexico, Iowa, and Hawaii).16 The Medicare data base contains information on hospital-discharge diagnoses from 1984 onward and information on the dates of death of the participants who have died.
We determined from the SEER data base the following characteristics of patients: sex, race, age at diagnosis, and stage of cancer (patients with unknown nodal status were excluded). We assigned a socioeconomic status to patients on the basis of the median income in the ZIP Code of residence (obtained from the 1990 U.S. Census). We used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)17 discharge codes from the admission during which surgery was performed to determine both the extent of chronic illness as measured by the Romano modification18 of the Charlson comorbidity index19 and the operation that was performed: partial lobectomy (wedge or segmental resection, ICD-9-CM code 32.2 or 32.3), lobectomy (ICD-9-CM code 32.1 or 32.4), or pneumonectomy (ICD-9-CM code 32.5 or 32.6).
The Nationwide Inpatient Sample
Hospitals were identified from the Nationwide Inpatient Sample (NIS).20 The NIS consists of a stratified random sample of 1012 hospitals in 22 states; data from 5 of these states (California, Connecticut, Iowa, Utah, and Washington) overlap with those from SEER regions and include American Hospital Association (AHA) hospital identifiers that make linkage between the two data bases possible. The NIS contains complete data on discharges from each participating hospital and reports the teaching status and type of location (urban or nonurban) of the hospital. We assigned to each hospital the characteristics and the annual volume of procedures that were documented for the 1997 discharges in the NIS. To calculate the volume of procedures, we counted the number of patients whose records indicated a diagnosis of lung cancer (principal NIS diagnosis code, 19) and the performance of lung resection (principal NIS procedure code, 36).
Study Patients
We analyzed data on 2118 patients in the SEER–Medicare data base who received a diagnosis of lung cancer between 1985 and 1996 and who underwent resection for lung cancer at 1 of 76 hospitals included in the NIS for 1997. These patients were drawn from the 12,921 patients 65 years old or older who resided in 1 of the 10 areas covered by the SEER data base and who met the following requirements: a diagnosis of primary cancer of the lung (International Classification of Diseases for Oncology, 2nd edition 21 [ICD-O-2] codes 34.0 through 34.9) between 1985 and 1996, with non–small-cell histologic features (ICD-O-2 morphology [M] codes other than 8000, 8002, 8041 through 8045, 8240, 8241, 8244, and 8246); stage I, II, or IIIA disease according to the criteria of the American Joint Committee on Cancer Staging22,23; indemnity insurance through the Medicare program; and lung resection within four months after diagnosis. The hospitals were drawn from the pool of 1012 hospitals that participate in the NIS, in 423 of which at least one operation for lung cancer was performed in 1997. The patients and hospitals we studied had characteristics similar to those in the parent data bases (Table 1Table 1
Characteristics of the Patients Identified through the SEER–Medicare Data Base and of the Hospitals Identified from the Nationwide Inpatient Sample That Were Included in or Excluded from the Study.), with the exception that more hospitals in our study were investor-owned rather than not-for-profit.Analyses of the Entire SEER–Medicare Cohort
The principal advantage of using the NIS to ascertain the volume of procedures is that it contains a count of the actual number of lung-cancer operations performed during one year at each hospital, but major disadvantages are that only a small proportion of the patients covered by the SEER–Medicare data base underwent their procedures at a facility that participated in the NIS and that the 1997 NIS data do not cover the same period as the SEER–Medicare data we used. We chose to use the NIS data because they allowed us to express results in terms of the actual volume of procedures. We also repeated all the analyses using the entire SEER–Medicare cohort, and when relevant, we report summary statistics and P values from these analyses, for which the characteristics of the hospitals were derived from the 1993 AHA data base.
Outcomes after Resection for Lung Cancer
We assessed survival and the frequency of postoperative complications after resection for lung cancer. We evaluated the absolute duration of survival from the date of hospitalization for surgery to the date of death as reported to Medicare, as well as the likelihood of survival at 30 days and 2 years. Records of deaths are complete through December 31, 1994, for patients with lung cancer diagnosed before 1991 and through December 31, 1998, for those with lung cancer diagnosed between 1991 and 1996. The follow-up for all patients was at least two years. For the patients who were still alive, data were censored as of these dates.
The frequency of postoperative complications and the length of stay after the admission for surgery were determined on the basis of claims in the Medicare file.24,25 We separated serious acute complications into surgical and pulmonary complications. Surgical complications included pneumothorax, pulmonary collapse, and accidental puncture, damage, or contamination of the surgical site (ICD-9-CM codes 512.0, 512.1, 512.8, 518, 518.1, 998.2 through 998.81, E870.0, and E871.0); pulmonary complications included new-onset pulmonary insufficiency and respiratory arrest (ICD-9-CM codes 518.5, 518.81, 518.82, 799.1, and 997.3). This group of diagnoses is distinct from those used to calculate the Romano–Charlson index, which we used to measure comorbidity. The latter index focuses on chronic illnesses such as congestive heart failure (ICD-9-CM codes 402 through 404), liver disease (ICD-9-CM code 572), and chronic obstructive pulmonary disease (ICD-9-CM codes 415.0, 416.8, 416.9, 491 through 494, and 496).
Statistical Analysis
The results are presented according to category of the hospital's volume of procedures exclusively for purposes of illustration. In all the statistical tests, the volume was considered as a continuous measure, and variances were adjusted to correct for the fact that these data include multiple observations from some hospitals. Categorical outcomes (30-day survival, 2-year survival, presence or absence of complications, and characteristics of the hospitals and the patients) were assessed by means of a modified version of the Mantel–Haenszel test for trend in all unadjusted analyses and by a method involving generalized estimating equations for all analyses that included other covariates.26-28 The association between the length of stay and the volume of procedures was assessed by means of the rank-correlation test. Survival data were assessed by means of a Cox proportional-hazards model in which we adjusted the variance using the Robust macro developed for use with SAS software (SAS Institute, Cary, N.C.).29 All analyses were performed with SAS software, version 8.0. All P values are two-sided. The categorizations of the covariates included in the models are reflected in Table 2Table 2
Characteristics of the 76 Hospitals Studied, According to the Volume of Lung-Cancer Resections Performed during 1997, and of 2118 Medicare Beneficiaries with Stage I, II, or IIIA Non–Small-Cell Lung Cancer Who Underwent Lung-Cancer Resection between 1985 and 1996 at One of These Hospitals., and the particular covariates included in each model are specified in Table 3Table 3
Relation between the Volume of Operations and the Outcome of Operations for Primary Non–Small-Cell Lung Cancer. and Table 4Table 4
Relation between the Volume of Procedures, Complications, and Survival after Operations for Primary Lung Cancer..Results
Characteristics of the Hospitals
For the purpose of illustration, the hospitals are categorized according to the number of lung-cancer operations performed in 1997 (Table 2). In nearly half the hospitals (34 of 76), fewer than nine lung-cancer operations were performed in that year. In contrast, at 16 of the 76 hospitals (21 percent) 20 to 66 procedures were performed in 1997, and at 2 hospitals (3 percent) 67 to 100 were performed. Hospitals in which higher numbers of lung-cancer operations were performed tended to be teaching hospitals in urban locations. There were no significant trends that associated the volume of procedures with the characteristics of the patients listed in Table 2.
The Relation between Volume and Outcome
The 30-day, 2-year, and overall rates of survival were all significantly associated with the volume of procedures (Table 3). The most important difference between high-volume and low-volume hospitals was in overall survival. The rate of survival at five years was 44 percent among patients who underwent resection at either of the two hospitals with the highest volume of procedures and 33 percent among patients who had surgery at a hospital in which fewer than nine operations were performed in 1997. An analysis of the entire SEER–Medicare cohort demonstrated a significant but more limited difference (7 percentage points; P<0.001) in five-year survival between the hospitals with the lowest volume (36 percent) and those with the highest volume (43 percent). We also observed that for each increment in the procedure-volume category, overall survival improved both in absolute terms (Figure 1Figure 1
Survival of Medicare Beneficiaries 65 Years of Age or Older Who Received a Diagnosis of Stage I, II, or IIIA Non–Small-Cell Lung Cancer between 1985 and 1996 and Underwent Resection for Lung Cancer, According to the Volume of Such Procedures Performed Annually at the Hospitals Where the Patients Were Treated.) and within analyses that adjusted for other factors that influence survival (Table 3).The Relation among Teaching Status, Volume, and Survival
Overall, the rate of five-year survival among patients who underwent surgery at a teaching hospital was 42 percent, as compared with 34 percent among those at nonteaching hospitals (P<0.001). After stratifying hospitals according to their volume of procedures, we also observed a relation between the rate of survival and the volume of procedures in teaching hospitals in particular (Table 3).
Postoperative Complications
We found a strong negative association between the volume of the procedures and the likelihood of either operative (P<0.001) or pulmonary (P=0.002) complications (Table 4), with complication rates that were twice as high at hospitals with the lowest volume as at those with the highest volume. We also observed a relation between longer hospital stays and hospitals with lower volume (Table 4). Although this latter association is unlikely to be clinically significant, it supports our hypothesis that the postoperative course at hospitals with lower volumes is, on average, more complex. The primary association between hospital volume and survival was only marginally altered when we simultaneously considered the effect of complications on survival through either stratified or multivariate analyses (Table 4). In other words, these results are not consistent with the hypothesis that differences in complication rates are the chief explanation for the relation between volume and survival.
Discussion
We found a rate of survival at five years that was higher by 11 percentage points (44 percent vs. 33 percent) among patients who underwent resections for lung cancer at hospitals with the highest volumes of such procedures than among those at the hospitals with the lowest volumes. Moreover, regardless of the volume of procedures, the rate of survival was better among patients who had their operations at teaching hospitals rather than nonteaching hospitals, although this finding did not confound the relation between volume and outcome.
Serious postoperative complications occurred at the hospitals with the lowest volume twice as often as at those with the highest volume (44 percent vs. 20 percent). It seemed plausible that these higher rates of complications might explain the relation between the hospital's volume of procedures and long-term survival. However, the complications we identified in the Medicare files only partially explained the association between high volume and a higher rate of overall survival. Whether a clearer picture would have emerged if we had more complete documentation of postoperative events (such as can be obtained through a review of patients' charts) remains an open question.
Our study has other limitations because of the incompleteness of the data on the hospitals and the patients included in NIS, Medicare, and the SEER data base. The hospitals included in the 1997 NIS are characterized simply as teaching or nonteaching, belying the complex array of organizational frameworks that exists. The 1997 data may also have limited relevance to patients who entered the cohort in the earlier years of our study. Incomplete data on adjuvant treatment and miscoded data on coexisting conditions (both potential problems with Medicare records) are also matters of concern. The lack of data on adjuvant treatment, however, should not have affected our results for two reasons. First, randomized trials have not demonstrated a consistent survival benefit for patients with stage I or stage II disease — a category that includes 89 percent of the patients in our study.30,31 Second, in a separate analysis of patients with early-stage disease, the results were similar to those in the cohort as a whole (data not shown).32
As for miscoding or incomplete coding of coexisting conditions,33 there were no discernible differences between the groups of patients in the characteristics we measured (Table 2), which lessens the likelihood that unobserved differences in these factors are an important source of bias. The staging information in the SEER data base may also have biased our results, especially because the sampling of mediastinal lymph nodes may be more thorough in hospitals with high volumes of procedures than in those with low volumes. However, among patients with stage IA (T1N0M0) disease who had undergone lobectomy (17 percent of the cohort), the relation between the volume of procedures and five-year survival was of the same magnitude as that in the entire cohort (data not shown). In this subgroup of patients, we know that the stage was probably ascertained correctly. At least one N1 node was examined, and the likelihood of a “skip” metastasis to the N2 node is very low (4 to 8 percent in most reports).34,35
How should we react to these findings? Survival might be improved by identifying the variations in perioperative and intraoperative care that are responsible for the differences we found. A study in which an association between volume and outcome was identified in the care of patients with myocardial infarction found that differential use of aspirin, beta-blockers, and other therapies accounted for some of the differences in outcome that appeared to be linked to the volume of procedures.36 An alternative response to our results would be to limit the performance of resections for lung cancer to centers with better outcomes. This approach has been endorsed by a number of investigators,37-40 as well as in a recent report from the Institute of Medicine on the quality of care for cancer in the United States.41
We hesitate to advocate this latter approach for three reasons. First, shifting surgical patients to a few institutions with high volumes of procedures may have unintended effects on the quality of care both at those institutions, which would face substantial increases in the volume of patients, and at the institutions with low volumes, where the care of the remaining patients might suffer. Second, increased volume and the teaching status of the hospital appear to be markers of improved outcome, but these characteristics do not, in isolation, identify individual high-quality hospitals.42 Finally, the association we observed between the volume of procedures and postoperative complications hints at the possibility that rectifiable variations in care may account for differences in outcome. Targeting these variations may be the best way to achieve a durable improvement in the treatment of patients with early-stage lung cancer.
Supported by a grant (RO1-CA-090226, to Dr. Bach) from the National Cancer Institute.
We are indebted to the staffs of the Applied Research Program, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Health Care Financing Administration; Information Management Services; the SEER Program tumor registries that created the SEER–Medicare data base; and the Healthcare Cost and Utilization Project, 1988 through 1997, that created the Nationwide Inpatient Sample; to Larry Kaiser and Joan Warren for their thoughtful input; and to Sheryl Rifas-Shiman and Sofia Yakren for their dedicated assistance. The interpretation and reporting of the data are the sole responsibility of the authors.
Source Information
From the Health Outcomes Research Group, the Departments of Epidemiology and Biostatistics (P.B.B., L.D.C., D.S., S.E.G., C.B.B.), Medicine (P.B.B., D.S.), and Surgery (R.J.D.), Memorial Sloan-Kettering Cancer Center, New York.
Address reprint requests to Dr. Bach at the Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 221, New York, NY 10021.
- References
References
1
Begg CB ,Cramer LD ,Hoskins WJ ,Brennan MF . Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280:1747-1751
CrossRef | Web of Science | Medline2
Sosa JA ,Bowman HM ,Gordon TA , et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998;228:429-438
CrossRef | Web of Science | Medline3
Birkmeyer JD ,Warshaw AL ,Finlayson SR ,Grove MR ,Tosteson AN . Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999;126:178-183
CrossRef | Web of Science | Medline4
Schrag D ,Cramer LD ,Bach PB ,Cohen AM ,Warren JL ,Begg CB . Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000;284:3028-3035
CrossRef | Web of Science | Medline5
Hannan EL ,O'Donnell JF ,Kilburn H Jr ,Bernard HR ,Yazici A . Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 1989;262:503-510
CrossRef | Web of Science | Medline6
Hannan EL ,Popp AJ ,Tranmer B ,Fuestel P ,Waldman J ,Shah D . Relationship between provider volume and mortality for carotid endarterectomies in New York State. Stroke 1998;29:2292-2297
CrossRef | Web of Science | Medline7
Hughes RG ,Hunt SS ,Luft HS . Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care 1987;25:489-503
CrossRef | Web of Science | Medline8
Edwards EB ,Roberts JP ,McBride MA ,Schulak JA ,Hunsicker LG . The effect of the volume of procedures at transplantation centers on mortality after liver transplantation. N Engl J Med 1999;341:2049-2053
Full Text | Web of Science | Medline9
Roohan PJ ,Bickell NA ,Baptiste MS ,Therriault GD ,Ferrara EP ,Siu AL . Hospital volume differences and five-year survival from breast cancer. Am J Public Health 1998;88:454-457
CrossRef | Web of Science | Medline10
Yao SL ,Lu-Yao G . Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst 1999;91:1950-1956
CrossRef | Web of Science | Medline11
Ellison LM ,Heaney JA ,Birkmeyer JD . The effect of hospital volume on mortality and resource use after radical prostatectomy. J Urol 2000;163:867-869
CrossRef | Web of Science | Medline12
Khuri SF ,Daley J ,Henderson W , et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999;230:414-429
CrossRef | Web of Science | Medline13
Romano PS ,Mark DH . Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. Chest 1992;101:1332-1337
CrossRef | Web of Science | Medline14
Rosenthal GE ,Harper DL ,Quinn LM ,Cooper GS . Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals: results of a regional study. JAMA 1997;278:485-490
CrossRef | Web of Science | Medline15
Holm T ,Johansson H ,Cedermark B ,Ekelund G ,Rutqvist L-E . Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997;84:657-663
CrossRef | Web of Science | Medline16
Potosky AL ,Riley GF ,Lubitz JD ,Mentnech RM ,Kessler LG . Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 1993;31:732-748
CrossRef | Web of Science | Medline17
1999 Hospital & payor ICD-9-CM: international classification of diseases, 9th rev., clinical modification. 5th ed. Salt Lake City: Medicode, 1998.
18
Romano PS ,Roos LL ,Jollis JG . Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46:1075-1079
CrossRef | Web of Science | Medline19
Charlson ME ,Pompei P ,Ales KL ,MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383
CrossRef | Medline20
Best AE . Secondary data bases and their use in outcomes research:a review of the Area Resource File and the Healthcare Cost and Utilization Project. J Med Syst 1999;23:175-181
CrossRef | Medline21
Percy C, Van Holten V, Muir C, eds. International classification of diseases for oncology. 2nd ed. Geneva: World Health Organization, 1990.
22
Mountain CF . A new international staging system for lung cancer. Chest 1986;89:Suppl:225S-233S
Web of Science | Medline23
Mountain CF . Revisions in the International System for Staging Lung Cancer. Chest 1997;111:1710-1717
CrossRef | Web of Science | Medline24
Iezzoni LI ,Daley J ,Heeren T , et al. Using administrative data to screen hospitals for high complication rates. Inquiry 1994;31:40-55
Web of Science | Medline25
Lawthers AG ,McCarthy EP ,Davis RB ,Peterson LE ,Palmer RH ,Iezzoni LI . Identification of in-hospital complications from claims data: is it valid? Med Care 2000;38:785-795
CrossRef | Web of Science | Medline26
Begg MD . Analyzing k (2×2) tables under cluster sampling. Biometrics 1999;55:302-307
CrossRef | Web of Science | Medline27
Diggle PJ, Liang K-Y, Zeger SL. Analysis of longitudinal data. Oxford, England: Oxford University Press, 1995.
28
Allison PD. Logistic regression using the SAS system: theory and application. Cary, N.C.: SAS Institute, 1999:179-97.
29
White H . Maximum likelihood estimation of misspecified models. Econometrica 1982;50:1-25
CrossRef | Web of Science30
Ettinger DS ,Cox JD ,Ginsberg RJ , et al. NCCN non-small-cell lung cancer practice guidelines. Oncology (Huntingt) 1996;10:Suppl:81-111
Medline31
Keller SM ,Adak S ,Wagner H , et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. N Engl J Med 2000;343:1217-1222
Full Text | Web of Science | Medline32
Rosell R ,Gomez-Codina J ,Camps C , et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med 1994;330:153-158
Full Text | Web of Science | Medline33
Jollis JG ,Ancukiewicz M ,DeLong ER ,Pryor DB ,Muhlbaier LH ,Mark DB . Discordance of databases designed for claims payment versus clinical information systems: implications for outcomes research. Ann Intern Med 1993;119:844-850
Web of Science | Medline34
Asamura H ,Nakayama H ,Kondo H ,Tsuchiya R ,Shimosata Y ,Naruke T . Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy? J Thorac Cardiovasc Surg 1996;111:1125-1134
CrossRef | Web of Science | Medline35
Ishida T ,Yano T ,Maeda K ,Kaneko S ,Tateishi M ,Sugimachi K . Strategy for lymphadenectomy in lung cancer three centimeters or less in diameter. Ann Thorac Surg 1990;50:708-713
CrossRef | Web of Science | Medline36
Thiemann DR ,Coresh J ,Oetgen WJ ,Powe NR . The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med 1999;340:1640-1648
Full Text | Web of Science | Medline37
Grumbach K ,Anderson GM ,Luft HS ,Roos LL ,Brook R . Regionalization of cardiac surgery in the United States and Canada: geographic access, choice, and outcomes. JAMA 1995;274:1282-1288
CrossRef | Web of Science | Medline38
Luft HS ,Bunker JP ,Enthoven AC . Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369
Full Text | Web of Science | Medline39
Hillner BE ,Smith TJ . Hospital volume and patient outcomes in major cancer surgery: a catalyst for quality assessment and concentration of cancer services. JAMA 1998;280:1783-1784
CrossRef | Web of Science | Medline40
Hillner BE ,Smith TJ ,Desch CE . Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 2000;18:2327-2340
Web of Science | Medline41
Hewitt M, ed. Interpreting the volume-outcome relationship in the context of health care quality: workshop summary. Washington, D.C.: National Academy of Sciences, 2000.
42
Phillips KA ,Luft HS . The policy implications of using hospital and physician volumes as “indicators“ of quality of care in a changing health care environment. Int J Qual Health Care 1997;9:341-348
Web of Science | Medline
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Nancy L. Keating, Mary Beth Landrum, John M. Brooks, Elizabeth A. Chrischilles, Eric P. Winer, Kara Wright, Rita Volya. (2011) Outcomes following local therapy for early-stage breast cancer in non-trial populations. Breast Cancer Research and Treatment 125:3, 803-813
CrossRef19
Shawn S. Groth, Beth A. Virnig, Waddah B. Al-Refaie, Stephanie L. Jarosek, Eric H. Jensen, Todd M. Tuttle. (2011) Appendiceal carcinoid tumors: Predictors of lymph node metastasis and the impact of right hemicolectomy on survival. Journal of Surgical Oncology 103:1, 39-45
CrossRef20
John R. Handy. (2011) Attributes Contributing to Superior Outcomes in the Surgical Management of Early-Stage Lung Cancer and Examples of Implementing Improvement. The Cancer Journal 17:1, 57-62
CrossRef21
Jeffrey W. Allen, Aamer Farooq, Thomas F. O'Brien, Raymond U. Osarogiagbon. (2011) Quality of surgical resection for nonsmall cell lung cancer in a US metropolitan area. Cancer 117:1, 134-142
CrossRef22
Tae Ho Yoon, Sang-Yi Lee, Chul-Woung Kim, Su Young Kim, Baek-Geun Jeong, Hyeung-Keun Park. (2011) Inequalities in Medical Care Utilization by South Korean Cancer Patients According to Income: A Retrospective Cohort Study. International Journal of Health Services 41:1, 51-66
CrossRef23
S Cicėnas, J Kurtinaitis, G Smailytė. (2010) Outcome and treatment strategy in female lung cancer: a single institution experience. Advances in Medical Sciences 55:2, 273-280
CrossRef24
Peter A. Learn, Peter B. Bach. (2010) A Decade of Mortality Reductions in Major Oncologic Surgery. Medical Care 48:12, 1041-1049
CrossRef25
Margaret M. Byrne, Tulay Koru-Sengul, Wei Zhao, Joel L. Weissfeld, Mark S. Roberts. (2010) Healthcare use after screening for lung cancer. Cancer 116:20, 4793-4799
CrossRef26
Amy Y. Chen, Stacey Fedewa, Alex Pavluck, Elizabeth M. Ward. (2010) Improved survival is associated with treatment at high-volume teaching facilities for patients with advanced stage laryngeal cancer. Cancer 116:20, 4744-4752
CrossRef27
Megan Dann Fesinmeyer, Bernardo Goulart, David K. Blough, Dedra Buchwald, Scott D. Ramsey. (2010) Lung cancer histology, stage, treatment, and survival in American Indians and Alaska Natives and whites. Cancer 116:20, 4810-4816
CrossRef28
Christian J. Finley, Anna Bendzsak, George Tomlinson, Shaf Keshavjee, David R. Urbach, Gail E. Darling. (2010) The effect of regionalization on outcome in pulmonary lobectomy: A Canadian national study. The Journal of Thoracic and Cardiovascular Surgery 140:4, 757-763
CrossRef29
M.W.J.M. Wouters, S. Siesling, M.L. Jansen-Landheer, M.A.G. Elferink, J. Belderbos, J.W. Coebergh, F.M.N.H. Schramel. (2010) Variation in treatment and outcome in patients with non-small cell lung cancer by region, hospital type and volume in the Netherlands. European Journal of Surgical Oncology (EJSO) 36, S83-S92
CrossRef30
M.W.J.M. Wouters, M.L.E.A. Jansen-Landheer, C.J.H. van de Velde. (2010) The quality of cancer care initiative in the Netherlands. European Journal of Surgical Oncology (EJSO) 36, S3-S13
CrossRef31
S. Seifert, A. Nemat. (2010) Die Rolle der Chirurgie beim Lungenkarzinom. Der Pneumologe 7:4, 237-244
CrossRef32
Matti Reinikainen, Sari Karlsson, Tero Varpula, Ilkka Parviainen, Esko Ruokonen, Marjut Varpula, Tero Ala-Kokko, Ville Pettilä. (2010) Are small hospitals with small intensive care units able to treat patients with severe sepsis?. Intensive Care Medicine 36:4, 673-679
CrossRef33
E. Carter Paulson, Najjia N. Mahmoud, Christopher Wirtalla, Katrina Armstrong. (2010) Acuity and Survival in Colon Cancer Surgery. Diseases of the Colon & Rectum 53:4, 385-392
CrossRef34
S. Senan, F. Lagerwaard. (2010) Stereotactic radiotherapy for stage I lung cancer: Current results and new developments. Cancer/Radiothérapie 14:2, 115-118
CrossRef35
Alessandro Brunelli. (2010) Risk Assessment for Pulmonary Resection. Seminars in Thoracic and Cardiovascular Surgery 22:1, 2-13
CrossRef36
L. Weißbach, C. Schaefer. (2010) Kontra Mindestmengen. best practice onkologie 5:1, 16-23
CrossRef37
Peter J Mazzone. (2010) Preoperative evaluation of the lung cancer resection candidate. Expert Review of Respiratory Medicine 4:1, 97-113
CrossRef38
Elisabeth T. Tracy, Kyla M. Bennett, Melissa E. Danko, Diana L. Diesen, Tammy J. Westmoreland, Paul C. Kuo, Theodore N. Pappas, Henry E. Rice, John E. Scarborough. (2010) Low volume is associated with worse patient outcomes for pediatric liver transplant centers. Journal of Pediatric Surgery 45:1, 108-113
CrossRef39
Ailsa Wilson, Nicholas E. Marlow, Guy J. Maddern, Bruce Barraclough, Neil A. Collier, Ian C. Dickinson, Jonathon Fawcett, John C. Graham. (2010) Radical prostatectomy: a systematic review of the impact of hospital and surgeon volume on patient outcome. ANZ Journal of Surgery 80:1-2, 24-29
CrossRef40
Yoann Thibout, Benoit Guibert, Nadine Bossard, François Tronc, Olivier Tiffet, Eric de la Roche, Pierre Mulsant, Jean-Paul Gamondes, Jacques Baulieux, Laurent Remontet, Laurence Geriniere, Pierre-Jean Souquet. (2009) Is Pneumonectomy After Induction Chemotherapy for Non-small Cell Lung Cancer a Reasonable Procedure? A Multicenter Retrospective Study of 228 Cases. Journal of Thoracic Oncology 4:12, 1496-1503
CrossRef41
E Carter Paulson, Christopher Wirtalla, Katrina Armstrong, Najjia N. Mahmoud. (2009) Gender Influences Treatment and Survival in Colorectal Cancer Surgery. Diseases of the Colon & Rectum 52:12, 1982-1991
CrossRef42
H. Hoffmann, H. Dienemann. (2009) Entwicklung der Thoraxchirurgie in den nächsten 20 Jahren. Der Chirurg 80:12, 1121-1125
CrossRef43
Stefano Mattarocci, Claudia Abbruzzese, Anna M. Mileo, Paolo Visca, Barbara Antoniani, Gabriele Alessandrini, Francesco Facciolo, Armando Felsani, Razvan T. Radulescu, Marco G. Paggi. (2009) Intracellular presence of insulin and its phosphorylated receptor in non-small cell lung cancer. Journal of Cellular Physiology 221:3, 766-770
CrossRef44
Douglas E. Wood, Farhood Farjah. (2009) Surgeon Specialty Is Associated With Better Outcomes: The Facts Speak for Themselves. The Annals of Thoracic Surgery 88:5, 1393-1395
CrossRef45
Deniz Hastan, Jan P. Vandenbroucke, Andel G. L. van der Mey. (2009) A Meta-Analysis of Surgical Treatment for Vestibular Schwannoma. Otology & Neurotology 30:7, 975-980
CrossRef46
Ashwin N. Ananthakrishnan, Emily L. McGinley, Kia Saeian. (2009) Higher hospital volume is associated with lower mortality in acute nonvariceal upper-GI hemorrhage. Gastrointestinal Endoscopy 70:3, 422-432
CrossRef47
Amy Y. Chen, Alex Pavluck, Michael Halpern, Elizabeth Ward. (2009) Impact of treating facilities' volume on survival for early-stage laryngeal cancer. Head & Neck 31:9, 1137-1143
CrossRef48
Johan Vansteenkiste, Christophe Dooms, Paul De Leyn. (2009) The multidisciplinarity of stage III non-small cell lung cancer. European Journal of Cancer 45, 92-105
CrossRef49
Elisabeth T. Tracy, Kyla M. Bennett, Emeline M. Aviki, Theodore N. Pappas, Bradley H. Collins, Janet E. Tuttle-Newhall, Carlos E. Marroquin, Paul C. Kuo, John E. Scarborough. (2009) Temporal trends in liver transplant centre volume in the USA. HPB 11:5, 414-421
CrossRef50
Nancy L. Keating, Elena Kouri, Yulei He, Jane C. Weeks, Eric P. Winer. (2009) Racial Differences in Definitive Breast Cancer Therapy in Older Women. Medical Care 47:7, 765-773
CrossRef51
Ralf Zahn, Uwe Zeymer. (2009) Akuter Myokardinfarkt: Akut-PCI in jedem Krankenhaus versus Akut-PCI im spezialisierten Zentrum. Herz Kardiovaskuläre Erkrankungen 34:3, 211-217
CrossRef52
Michael C. Cheung, Leonidas G. Koniaris, Eduardo A. Perez, Manuel A. Molina, W. Jarred Goodwin, Rabih M. Salloum. (2009) Impact of Hospital Volume on Surgical Outcome for Head and Neck Cancer. Annals of Surgical Oncology 16:4, 1001-1009
CrossRef53
Farhood Farjah, David R. Flum, Scott D. Ramsey, Patrick J. Heagerty, Rebecca Gaston Symons, Douglas E. Wood. (2009) Multi-Modality Mediastinal Staging for Lung Cancer Among Medicare Beneficiaries. Journal of Thoracic Oncology 4:3, 355-363
CrossRef54
Jordi Freixinet, Araceli Caballero-Hidalgo, Beatriz González López-Valcárcel, José Luis García Fernández, Íñigo Crespo Royo, Ángel Salvatierra Velázquez, Emilio Canalís Arrayás, Manuel Sánchez García, Juan Torres Lanzas, Gonzalo Varela Simó, Ignacio Muguruza Trueba, Manuel Mariñán Gorospe, A. Cantó Armengod. (2009) Análisis de la situación actual y previsión de futuro de la especialidad de cirugía torácica. Archivos de Bronconeumología 45:3, 107-110
CrossRef55
Andreas du Bois, Justine Rochon, Jacobus Pfisterer, William J. Hoskins. (2009) Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: A systematic review. Gynecologic Oncology 112:2, 422-436
CrossRef56
Ashwin N. Ananthakrishnan, Emily L. McGinley, Kia Saeian. (2009) Higher hospital volume predicts endoscopy but not the in-hospital mortality rate in patients with acute variceal hemorrhage. Gastrointestinal Endoscopy 69:2, 221-229
CrossRef57
P. P. Reese, H. Yeh, A. M. Thomasson, J. Shults, J. F. Markmann. (2009) Transplant Center Volume and Outcomes After Liver Retransplantation. American Journal of Transplantation 9:2, 309-317
CrossRef58
Aileen B. Chen, Anthony V. D'Amico, Bridget A. Neville, Ewout W. Steyerberg, Craig C. Earle. (2009) Provider Case Volume and Outcomes Following Prostate Brachytherapy. The Journal of Urology 181:1, 113-118
CrossRef59
Michael C. Cheung, Kara Hamilton, Recinda Sherman, Margaret M. Byrne, Dao M. Nguyen, Dido Franceschi, Leonidas G. Koniaris. (2009) Impact of Teaching Facility Status and High-Volume Centers on Outcomes for Lung Cancer Resection: An Examination of 13,469 Surgical Patients. Annals of Surgical Oncology 16:1, 3-13
CrossRef60
Maximino Redondo, Francisco Rivas-Ruiz, M. Carmen Guzman-Soler, Carlos Labajos. (2008) Monitoring indicators of health care quality by means of a hospital register of tumours. Journal of Evaluation in Clinical Practice 14:6, 1026-1030
CrossRef61
Joaquín Sanchis. (2008) ¿Cuanto más azúcar, más dulce?. Archivos de Bronconeumología 44:11, 584-585
CrossRef62
Talya Salz, Robert S. Sandler. (2008) The Effect of Hospital and Surgeon Volume on Outcomes for Rectal Cancer Surgery. Clinical Gastroenterology and Hepatology 6:11, 1185-1193
CrossRef63
Ashwin N. Ananthakrishnan, Emily L. McGinley, David G. Binion. (2008) Does It Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide Analysis of Hospital Volume. The American Journal of Gastroenterology 103:11, 2789-2798
CrossRef64
Benjamin D. Kozower, George J. Stukenborg, Christine L. Lau, David R. Jones. (2008) Measuring the Quality of Surgical Outcomes in General Thoracic Surgery: Should Surgical Volume Be Used to Direct Patient Referrals?. The Annals of Thoracic Surgery 86:5, 1405-1408
CrossRef65
Peter B. Bach. (2008) Do Surgical Quality Gaps Cause Healthcare Disparities?. Medical Care 46:9, 889-892
CrossRef66
Ashwin N. Ananthakrishnan, Emily L. McGinley, Kia Saeian. (2008) Effect of hospital volume and teaching status on outcomes of acute liver failure. Liver Transplantation 14:9, 1347-1356
CrossRef67
Farhood Farjah, Douglas E. Wood, Thomas K. Varghese, Rebecca Gaston Symons, David R. Flum. (2008) Trends in the Operative Management and Outcomes of T4 Lung Cancer. The Annals of Thoracic Surgery 86:2, 368-374
CrossRef68
Christopher R. Friese, Eileen T. Lake, Linda H. Aiken, Jeffrey H. Silber, Julie Sochalski. (2008) Hospital Nurse Practice Environments and Outcomes for Surgical Oncology Patients. Health Services Research 43:4, 1145-1163
CrossRef69
Sasako, Mitsuru, Sano, Takeshi, Yamamoto, Seiichiro, Kurokawa, Yukinori, Nashimoto, Atsushi, Kurita, Akira, Hiratsuka, Masahiro, Tsujinaka, Toshimasa, Kinoshita, Taira, Arai, Kuniyoshi, Yamamura, Yoshitaka, Okajima, Kunio, . (2008) D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer. New England Journal of Medicine 359:5, 453-462
Full Text70
Frank C. Detterbeck, Christopher J. Gibson. (2008) Turning Gray: The Natural History of Lung Cancer Over Time. Journal of Thoracic Oncology 3:7, 781-792
CrossRef71
Jin Ra, E. Carter Paulson, John Kucharczuk, Katrina Armstrong, Christopher Wirtalla, Rachel Rapaport-Kelz, Larry R. Kaiser, Francis R. Spitz. (2008) Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model. Annals of Surgical Oncology 15:6, 1577-1584
CrossRef72
Kevin G. Billingsley, Arden M. Morris, Pamela Green, Jason A. Dominitz, Barbara Matthews, Sharon A. Dobie, William Barlow, Laura-Mae Baldwin. (2008) Does Surgeon Case Volume Influence Nonfatal Adverse Outcomes after Rectal Cancer Resection?. Journal of the American College of Surgeons 206:6, 1167-1177
CrossRef73
Wilson W.L. Li, Otto Visser, Dirk T. Ubbink, Houke M. Klomp, Jaap J. Kloek, Bas A.J.M. de Mol. (2008) The influence of provider characteristics on resection rates and survival in patients with localized non-small cell lung cancer. Lung Cancer 60:3, 441-451
CrossRef74
Farhood Farjah, Douglas E. Wood, David Yanez, Rebecca G. Symons, Bahirathan Krishnadasan, David R. Flum. (2008) Temporal Trends in the Management of Potentially Resectable Lung Cancer. The Annals of Thoracic Surgery 85:6, 1850-1856
CrossRef75
Walter Artibani, Giacomo Novara. (2008) Cancer-Related Outcome and Learning Curve in Retropubic Radical Prostatectomy: “If You Need an Operation, the Most Important Step is to Choose the Right Surgeon”. European Urology 53:5, 874-876
CrossRef76
Fernando J. Bianco. (2008) Radical prostatectomy: Surgical planning, execution, and outcomes. Current Urology Reports 9:3, 231-236
CrossRef77
Robert A. Meguid, Benjamin S. Brooke, David C. Chang, J. Timothy Sherwood, Malcolm V. Brock, Stephen C. Yang. (2008) Are Surgical Outcomes for Lung Cancer Resections Improved at Teaching Hospitals?. The Annals of Thoracic Surgery 85:3, 1015-1025
CrossRef78
Aaron M. Allen, Steven J. Mentzer, Beow Y. Yeap, Ricardo Soto, Elizabeth H. Baldini, Michael S. Rabin, David J. Sugarbaker, Raphael Bueno. (2008) Pneumonectomy after chemoradiation. Cancer 112:5, 1106-1113
CrossRef79
D. L. Hershman, D. Buono, R. B. McBride, W. Y. Tsai, K. A. Joseph, V. R. Grann, J. S. Jacobson. (2008) Surgeon Characteristics and Receipt of Adjuvant Radiotherapy in Women With Breast Cancer. JNCI Journal of the National Cancer Institute 100:3, 199-206
CrossRef80
Bridie Thompson, Peter Baade, Michael Coory, Philippe Carrière, Lin Fritschi. (2008) Patterns of Surgical Treatment for Women Diagnosed with Early Breast Cancer in Queensland. Annals of Surgical Oncology 15:2, 443-451
CrossRef81
Daniel J. Boffa, Mark S. Allen, Joshua D. Grab, Henning A. Gaissert, David H. Harpole, Cameron D. Wright. (2008) Data from The Society of Thoracic Surgeons General Thoracic Surgery database: The surgical management of primary lung tumors. The Journal of Thoracic and Cardiovascular Surgery 135:2, 247-254
CrossRef82
Emily Carter Paulson, Nandita Mitra, Seema Sonnad, Katrina Armstrong, Christopher Wirtalla, Rachel Rapaport Kelz, Najjia N. Mahmoud. (2008) National Cancer Institute Designation Predicts Improved Outcomes in Colorectal Cancer Surgery. Transactions of the ... Meeting of the American Surgical Association 126, 318-329
CrossRef83
Gerard A. Silvestri. (2008) The Evolution of Bronchoscopy Training. Respiration 76:1, 19-20
CrossRef84
Michael W. Wouters, Bas P. Wijnhoven, Henrieke E. Karim-Kos, Harriet G. Blaauwgeers, Laurents P. Stassen, Willem-Hans Steup, Huug W. Tilanus, Rob A. Tollenaar. (2008) High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical Data. Annals of Surgical Oncology 15:1, 80-87
CrossRef85
S. Xirasagar, Y.C. Lien, H.C. Lin, H.C. Lee, T.C. Liu, J. Tsai. (2008) Procedure volume of gastric cancer resections versus 5-year survival. European Journal of Surgical Oncology (EJSO) 34:1, 23-29
CrossRef86
Thanos Sioris, Eero Sihvo, Risto Sankila, Jarmo Salo. (2008) Effect of surgical volume and hospital type on outcome in non-small cell lung cancer surgery: A Finnish population-based study. Lung Cancer 59:1, 119-125
CrossRef87
William C. Black. (2007) Computed tomography screening for lung cancer: Review of screening principles and update on current status. Cancer 110:11, 2370-2384
CrossRef88
Hes A. P. Brokx, Otto Visser, Pieter E. Postmus, Marinus A. Paul. (2007) Surgical Treatment for Octogenarians with Lung Cancer: Results from a Population-Based Series of 124 Patients. Journal of Thoracic Oncology 2:11, 1013-1017
CrossRef89
Shimul A. Shah, Rudy Bromberg, Angela Coates, Eddy Rempel, Marko Simunovic, Steven Gallinger. (2007) Survival after Liver Resection for Metastatic Colorectal Carcinoma in a Large Population. Journal of the American College of Surgeons 205:5, 676-683
CrossRef90
D. Kaiser. (2007) Mindestmengen aus thoraxchirurgischer Sicht. Der Chirurg 78:11, 1012-1017
CrossRef91
Filipa Costa, Fernando J. Barata, Jorge Pires. (2007) Abordagem terapêutica do carcinoma pulmonar de não pequenas células no idoso. Revista Portuguesa de Pneumologia (English Edition) 13:6, 841-854
CrossRef92
Mariëlle M. M. T. J. Ouwens, Rosella R. P. M. G. Hermens, René A. R. Termeer, Saskia Y. Vonk-Okhuijsen, Vivianne C. G. Tjan-Heijnen, Ad F. T. M. Verhagen, Marlies M. E. J. L. Hulscher, Henri A. M. Marres, Hub C. H. Wollersheim, Richard P. T. M. Grol. (2007) Quality of integrated care for patients with nonsmall cell lung cancer. Cancer 110:8, 1782-1790
CrossRef93
G. Massard. (2007) Critères de qualité de la chirurgie d’exérèse des cancers bronchiques non microcellulaires. Revue des Maladies Respiratoires 24:8, 40-49
CrossRef94
Hiroaki Osada, Etsuko Yamakoshi. (2007) Hospital volume and surgical outcomes of lung cancer in Japan. General Thoracic and Cardiovascular Surgery 55:9, 360-365
CrossRef95
Sudhir Sundaresan, Bernard Langer, Tom Oliver, Farrah Schwartz, Melissa Brouwers, Hartley Stern. (2007) Standards for Thoracic Surgical Oncology in a Single-Payer Healthcare System. The Annals of Thoracic Surgery 84:2, 693-701
CrossRef96
Charles J. Neighbors, Michelle L. Rogers, Edmond D. Shenassa, Christopher N. Sciamanna, Melissa A. Clark, Scott P. Novak. (2007) Ethnic/Racial Disparities in Hospital Procedure Volume for Lung Resection for Lung Cancer. Medical Care 45:7, 655-663
CrossRef97
N. Girard, C. Hennequin, F. Mornex. (2007) Chimioradiothérapie néoadjuvante des cancers bronchopulmonaires non à petites cellules. Oncologie 9:6, 475-481
CrossRef98
John D. Birkmeyer, Yating Sun, Sandra L. Wong, Therese A. Stukel. (2007) Hospital Volume and Late Survival After Cancer Surgery. Annals of Surgery 245:5, 777-783
CrossRef99
Katherine S. Panageas, Deborah Schrag, A. Russell Localio, E. S. Venkatraman, Colin B. Begg. (2007) Properties of analysis methods that account for clustering in volume–outcome studies when the primary predictor is cluster size. Statistics in Medicine 26:9, 2017-2035
CrossRef100
Kaye M. Reid-Lombardo, Greer Gay, Lina Patel-Parekh, Jaffer A. Ajani, John H. Donohue, . (2007) Treatment of Gastric Adenocarcinoma May Differ Among Hospital Types in the United States, a Report from the National Cancer Data Base. Journal of Gastrointestinal Surgery 11:4, 410-420
CrossRef101
D. H. Johnson, V. W. Rusch, A. T. Turrisi. (2007) Scalpels, Beams, Drugs, and Dreams: Challenges of Stage IIIA-N2 Non-Small-Cell Lung Cancer. JNCI Journal of the National Cancer Institute 99:6, 415-418
CrossRef102
Peter C. Enzinger, Jacqueline K. Benedetti, Jeffrey A. Meyerhardt, Sheryl McCoy, Scott A. Hundahl, John S. Macdonald, Charles S. Fuchs. (2007) Impact of Hospital Volume on Recurrence and Survival After Surgery for Gastric Cancer. Annals of Surgery 245:3, 426-434
CrossRef103
(2007) CT Screening for Lung Cancer. New England Journal of Medicine 356:7, 743-747
Full Text104
M. M. Chowdhury, H. Dagash, A. Pierro. (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. British Journal of Surgery 94:2, 145-161
CrossRef105
Jennifer L. Dodge, Paul K. Mills, Deborah G. Riordan. (2007) Cancer Survival in California Hispanic Farmworkers, 1988-2001. The Journal of Rural Health 23:1, 33-41
CrossRef106
P. G. Northup, T. L. Pruett, G. J. Stukenborg, C. L. Berg. (2006) Survival After Adult Liver Transplantation Does Not Correlate with Transplant Center Case Volume in the MELD Era. American Journal of Transplantation 6:10, 2455-2462
CrossRef107
Sydney M. Dy, Phoebe Sharkey, Robert Herbert, Kathleen Haddad, Albert W. Wu. (2006) Comorbid illnesses and health care utilization among Medicare beneficiaries with lung cancer. Critical Reviews in Oncology/Hematology 59:3, 218-225
CrossRef108
Kahn, Jeremy M., Goss, Christopher H., Heagerty, Patrick J., Kramer, Andrew A., O'Brien, Chelsea R., Rubenfeld, Gordon D., . (2006) Hospital Volume and the Outcomes of Mechanical Ventilation. New England Journal of Medicine 355:1, 41-50
Full Text109
John D. Birkmeyer, Yating Sun, Aaron Goldfaden, Nancy J.O. Birkmeyer, Therese A. Stukel. (2006) Volume and process of care in high-risk cancer surgery. Cancer 106:11, 2476-2481
CrossRef110
Lorenzo E. Ferri, Simon Law, Kam-Ho Wong, Ka-Fai Kwok, John Wong. (2006) The Influence of Technical Complications on Postoperative Outcome and Survival After Esophagectomy. Annals of Surgical Oncology 13:4, 557-564
CrossRef111
Peter D. Baade, Lin Fritschi, Elizabeth G. Eakin. (2006) Non-Cancer Mortality among People Diagnosed with Cancer (Australia). Cancer Causes & Control 17:3, 287-297
CrossRef112
J. Lipscomb. (2006) Transcending the Volume-Outcome Relationship in Cancer Care. JNCI Journal of the National Cancer Institute 98:3, 151-154
CrossRef113
D. Schrag, C. Earle, F. Xu, K. S. Panageas, K. R. Yabroff, R. E. Bristow, E. L. Trimble, J. L. Warren. (2006) Associations Between Hospital and Surgeon Procedure Volumes and Patient Outcomes After Ovarian Cancer Resection. JNCI Journal of the National Cancer Institute 98:3, 163-171
CrossRef114
Fausto Meriggi, Alberto Zaniboni. (2006) Non-small-cell lung cancer in the elderly. Critical Reviews in Oncology/Hematology 57:2, 183-190
CrossRef115
Ö. Birim, A.P. Kappetein, R.J. van Klaveren, A.J.J.C. Bogers. (2006) Prognostic factors in non-small cell lung cancer surgery. European Journal of Surgical Oncology (EJSO) 32:1, 12-23
CrossRef116
Ronald Damhuis, Aman Coonar, Peter Plaisier, Marlies Dankers, Jos Bekkers, Karen Linklater, Henrik Møller. (2006) A case-mix model for monitoring of postoperative mortality after surgery for lung cancer. Lung Cancer 51:1, 123-129
CrossRef117
Min Kyu Kang, Yong Chan Ahn, Do Hoon Lim, Keunchil Park, Joon Oh Park, Young Mog Shim, Jhingook Kim, Kwhanmien Kim. (2006) Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer. Journal of Korean Medical Science 21:2, 229
CrossRef118
Ugo Pastorino. (2006) Early Detection of Lung Cancer. Respiration 73:1, 5-13
CrossRef119
Neil Hanlon, Chris Skedgel. (2006) Cross-district utilization of general hospital care in Nova Scotia: Policy and service delivery implications for rural districts. Social Science & Medicine 62:1, 145-156
CrossRef120
Brahmajee K. Nallamothu, Kim A. Eagle, Victor A. Ferraris, Robert M. Sade. (2005) Should Coronary Artery Bypass Grafting Be Regionalized?. The Annals of Thoracic Surgery 80:5, 1572-1581
CrossRef121
S??ren Rasmussen, Ann-Dorthe O. Zwisler, Steen Z. Abildstrom, Jan K. Madsen, Mette Madsen. (2005) Hospital Variation in Mortality After First Acute Myocardial Infarction in Denmark From 1995 to 2002. Medical Care 43:10, 970-978
CrossRef122
Linda S. Elting, Curtis Pettaway, B. Nebiyou Bekele, H. Barton Grossman, Catherine Cooksley, Elenir B. C. Avritscher, Kamaldeen Saldin, Colin P. N. Dinney. (2005) Correlation between annual volume of cystectomy, professional staffing, and outcomes. Cancer 104:5, 975-984
CrossRef123
George J. Stukenborg, Kerry L. Kilbridge, Douglas P. Wagner, Frank E. Harrell, M. Norman Oliver, Jason A. Lyman, Jonathan S. Einbinder, Alfred F. Connors. (2005) Present-at-admission diagnoses improve mortality risk adjustment and allow more accurate assessment of the relationship between volume of lung cancer operations and mortality risk. Surgery 138:3, 498-507
CrossRef124
Emilie Perrot, Benoit Guibert, Pierre Mulsant, Sonia Blandin, Isabelle Arnaud, Pascal Roy, Laurence Geriniere, Pierre-Jean Souquet. (2005) Preoperative Chemotherapy Does Not Increase Complications After Nonsmall Cell Lung Cancer Resection. The Annals of Thoracic Surgery 80:2, 423-427
CrossRef125
L ELLISON, B TROCK, N POE, A PARTIN. (2005) THE EFFECT OF HOSPITAL VOLUME ON CANCER CONTROL AFTER RADICAL PROSTATECTOMY. The Journal of Urology 173:6, 2094-2098
CrossRef126
F BIANCOJR, E RIEDEL, C BEGG, M KATTAN, P SCARDINO. (2005) VARIATIONS AMONG HIGH VOLUME SURGEONS IN THE RATE OF COMPLICATIONS AFTER RADICAL PROSTATECTOMY: FURTHER EVIDENCE THAT TECHNIQUE MATTERS. The Journal of Urology 173:6, 2099-2103
CrossRef127
Renee Manser, Andrew Dalton, Rob Carter, Graham Byrnes, Mark Elwood, Donald A. Campbell. (2005) Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer 48:2, 171-185
CrossRef128
Eveline L. P. E. Geubbels, Jan C. Wille, Nico J. D. Nagelkerke, Christina M. J. E. Vandenbroucke‐Grauls, Diederick E. Grobbee, Annette S. de Boer. (2005) Hospital‐Related Determinants for Surgical‐Site Infection Following Hip Arthroplasty • . Infection Control and Hospital Epidemiology 26:5, 435-441
CrossRef129
David R. Urbach, Peter C. Austin. (2005) Conventional models overestimate the statistical significance of volume–outcome associations, compared with multilevel models. Journal of Clinical Epidemiology 58:4, 391-400
CrossRef130
S. D. Killeen, M. J. O'Sullivan, J. C. Coffey, W. O. Kirwan, H. P. Redmond. (2005) Provider volume and outcomes for oncological procedures. British Journal of Surgery 92:4, 389-402
CrossRef131
Stephen Lyman, Edward C Jones, Peter B Bach, Margaret G. E Peterson, Robert G Marx. (2005) The Association between Hospital Volume and Total Shoulder Arthroplasty Outcomes. Clinical Orthopaedics and Related Research &NA;:432, 132-137
CrossRef132
Sietske A. Smulders, Frank W.J.M. Smeenk, Maryska L.G. Janssen-Heijnen, Pascal L.M.L. Wielders, Dirk R.A.J. de Munck, Pieter E. Postmus. (2005) Surgical mediastinal staging in daily practice. Lung Cancer 47:2, 243-251
CrossRef133
M. Siess. (2005) Chancen und Risiken der Mindestmengenregelung f
r die Onkologie. Der Onkologe 11:2, 190-197
CrossRef134
Renée Manser, Gavin Wright, David Hart, Graham Byrnes, Donald Campbell, Renée Manser. 2005. Surgery for early stage non-small cell lung cancer. .
CrossRef135
Yuman Fong, Mithat Gonen, David Rubin, Mark Radzyner, Murray F. Brennan. (2005) Long-Term Survival Is Superior After Resection for Cancer in High-Volume Centers. Transactions of the ... Meeting of the American Surgical Association 123:&NA;, 234-241
CrossRef136
Kym Mina, Michael J. Byrne, Gerard Ryan, Lin Fritschi, Mark Newman, David Joseph, Chris Harper, Evan Bayliss, Marlene Kolybaba, Konrad Jamrozik. (2004) Surgical management of lung cancer in Western Australia in 1996 and its outcomes. ANZ Journal of Surgery 74:12, 1076-1081
CrossRef137
Rachel Rapaport Kelz, Phyllis A. Gimotty, Daniel Polsky, Sandra Norman, Douglas Fraker, Angela DeMichele. (2004) Morbidity and mortality of colorectal carcinoma surgery differs by insurance status. Cancer 101:10, 2187-2194
CrossRef138
Elena Losina, Jane Barrett, John A. Baron, Matthew Levy, Charlotte B. Phillips, Jeffrey N. Katz. (2004) Utilization of low-volume hospitals for total hip replacement. Arthritis & Rheumatism 51:5, 836-842
CrossRef139
Niall O'Higgins. (2004) The world federation of surgical oncology societies: The global mission. Journal of Surgical Oncology 87:3, 109-115
CrossRef140
David Ost, Alan Fein. (2004) Management strategies for the solitary pulmonary nodule. Current Opinion in Pulmonary Medicine 10:4, 272-278
CrossRef141
David A. Axelrod, Mary K. Guidinger, Keith P. McCullough, Alan B. Leichtman, Jeffrey D. Punch, Robert M. Merion. (2004) Association of Center Volume with Outcome After Liver and Kidney Transplantation. American Journal of Transplantation 4:6, 920-927
CrossRef142
George J. Stukenborg, Douglas P. Wagner, Frank E. Harrell. (2004) Temporal Order and Nonlinearity in the Relationship Between Lung Cancer Resection Volume and In-Hospital Mortality. Health Services and Outcomes Research Methodology 5:1, 59-73
CrossRef143
Hitoshi Ueda, Takashi Sakada, Motohisa Kuwahara, Akira Motohiro. (2004) A small randomized phase III single-center trial on postoperative UFT administration in patients with completely resected non-small cell lung cancer. Anti-Cancer Drugs 15:1, 29-33
CrossRef144
Ingemar Ihse. (2003) The Volume-Outcome Relationship in Cancer Surgery. Annals of Surgery 238:6, 777-781
CrossRef145
Kizer, Kenneth W., . (2003) The Volume–Outcome Conundrum. New England Journal of Medicine 349:22, 2159-2161
Full Text146
DeWitte T. Cross, David L. Tirschwell, Mary Ann Clark, Dan Tuden, Colin P. Derdeyn, Christopher J. Moran, Ralph G. Dacey. (2003) Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states. Journal of Neurosurgery 99:5, 810-817
CrossRef147
Etsuko Nomura, Hideaki Tsukuma, Wakiko Ajiki, Akira Oshima. (2003) Population-based study of relationship between hospital surgical volume and 5-year survival of stomach cancer patients in Osaka, Japan. Cancer Science 94:11, 998-1002
CrossRef148
Laurent G. Glance, Andrew W. Dick, Dana B. Mukamel, Turner M. Osler. (2003) Is the hospital volume-mortality relationship in coronary artery bypass surgery the same for low-risk versus high-risk patients?. The Annals of Thoracic Surgery 76:4, 1155-1162
CrossRef149
Kazim Sheikh. (2003) Reliability of Provider Volume and Outcome Associations for Healthcare Policy. Medical Care 41:10, 1111-1117
CrossRef150
Elizabeth E. Warner, James L. Mulshine. (2003) Surgical considerations with lung cancer screening. Journal of Surgical Oncology 84:1, 1-6
CrossRef151
Michael Y. Chang, David J. Sugarbaker. (2003) Surgery for early stage non-small cell lung cancer. Seminars in Surgical Oncology 21:2, 74-84
CrossRef152
Ugo Pastorino, Massimo Bellomi, Claudio Landoni, Elvio De Fiori, Patrizia Arnaldi, Maria Picchio, Giuseppe Pelosi, Peter Boyle, Ferruccio Fazio. (2003) Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. The Lancet 362:9384, 593-597
CrossRef153
Jerome H Liu, David A Etzioni, Jessica B O'Connell, Melinda A Maggard, Clifford Y Ko. (2003) Using Volume Criteria: Do California Hospitals Measure Up?. Journal of Surgical Research 113:1, 96-101
CrossRef154
Ost, David, Fein, Alan M., Feinsilver, Steven H., . (2003) The Solitary Pulmonary Nodule. New England Journal of Medicine 348:25, 2535-2542
Full Text155
Deborah Schrag, Katherine S. Panageas, Elyn Riedel, Lillian Hsieh, Peter B. Bach, Jose G. Guillem, Colin B. Begg. (2003) Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. Journal of Surgical Oncology 83:2, 68-78
CrossRef156
D. C. Hodgson, W. Zhang, A. M. Zaslavsky, C. S. Fuchs, W. E. Wright, J. Z. Ayanian. (2003) Relation of Hospital Volume to Colostomy Rates and Survival for Patients With Rectal Cancer. JNCI Journal of the National Cancer Institute 95:10, 708-716
CrossRef157
Emily V.A Finlayson, John D Birkmeyer. (2003) Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. Journal of the American College of Surgeons 196:3, 410-417
CrossRef158
Kevin A. Schulman, Damon M. Seils. (2003) Improving patients' experiences with cancer treatment. Clinical Therapeutics 25:2, 665-670
CrossRef159
Kristin A. Skinner, James T. Helsper, Dennis Deapen, Wei Ye, Richard Sposto. (2003) Breast Cancer: Do Specialists Make a Difference?. Annals of Surgical Oncology 10:6, 606-615
CrossRef160
David R. Urbach, Chaim M. Bell, Lee L. Swanstrom, Paul D. Hansen. (2003) Cohort Study of Surgical Bypass to the Gallbladder or Bile Duct for the Palliation of Jaundice due to Pancreatic Cancer. Annals of Surgery 237:1, 86-93
CrossRef161
Deborah Schrag, Katherine S. Panageas, Elyn Riedel, Laura D. Cramer, Jose G. Guillem, Peter B. Bach, Colin B. Begg. (2002) Hospital and Surgeon Procedure Volume as Predictors of Outcome Following Rectal Cancer Resection. Annals of Surgery 236:5, 583-592
CrossRef162
Marsha Lesley, Marilyn H. Oermann. (2002) Directory of Internet Documents for Consumers on Quality of Care. Journal for Healthcare Quality 24:5, 19-25
CrossRef163
M.L.E.A. Landheer, P. Therasse, C.J.H. van de Velde. (2002) The importance of quality assurance in surgical oncology. European Journal of Surgical Oncology (EJSO) 28:6, 571-602
CrossRef164
Mark D. McKee, Michael D. Cropp, Andrew Hyland, Nancy Watroba, Brian McKinley, Stephen B. Edge. (2002) Provider case volume and outcome in the evaluation and treatment of patients with mammogram-detected breast carcinoma. Cancer 95:4, 704-712
CrossRef165
Philip P Goodney, Andrea E Siewers, Therese A Stukel, F.Lee Lucas, David E Wennberg, John D Birkmeyer. (2002) Is surgery getting safer? National trends in operative mortality1,2 1No competing interests declared. 2The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.. Journal of the American College of Surgeons 195:2, 219-227
CrossRef166
Deborah Schrag, Peter B. Bach, Celia Dahlman, Joan L. Warren. (2002) Identifying and Measuring Hospital Characteristics Using the SEER-Medicare Data and Other Claims-Based Sources. Medical Care 40:Supplement, IV-96-IV-103
CrossRef167
Glen A. Lillington. (2002) Editorial overview: lung cancer. Current Opinion in Pulmonary Medicine 8:4, 247-250
CrossRef168
Joseph L Miller. (2002) What’s new in general thoracic surgery. Journal of the American College of Surgeons 195:1, 55-71
CrossRef169
Begg, Colin B., Riedel, Elyn R., Bach, Peter B., Kattan, Michael W., Schrag, Deborah, Warren, Joan L., Scardino, Peter T., . (2002) Variations in Morbidity after Radical Prostatectomy. New England Journal of Medicine 346:15, 1138-1144
Full Text170
McNeil, Barbara J., . (2001) Hidden Barriers to Improvement in the Quality of Care. New England Journal of Medicine 345:22, 1612-1620
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