Special Article
Surgeon Volume and Operative Mortality in the United States
N Engl J Med 2003; 349:2117-2127November 27, 2003
- Abstract
Background
Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain.
Methods
Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers.
Results
Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The adjusted odds ratio for operative death (for patients with a low-volume surgeon vs. those with a high-volume surgeon) varied widely according to the procedure — from 1.24 for lung resection to 3.61 for pancreatic resection. Surgeon volume accounted for a large proportion of the apparent effect of the hospital volume, to an extent that varied according to the procedure: it accounted for 100 percent of the effect for aortic-valve replacement, 57 percent for elective repair of an abdominal aortic aneurysm, 55 percent for pancreatic resection, 49 percent for coronary-artery bypass grafting, 46 percent for esophagectomy, 39 percent for cystectomy, and 24 percent for lung resection. For most procedures, the mortality rate was higher among patients of low-volume surgeons than among those of high-volume surgeons, regardless of the surgical volume of the hospital in which they practiced.
Conclusions
For many procedures, the observed associations between hospital volume and operative mortality are largely mediated by surgeon volume. Patients can often improve their chances of survival substantially, even at high-volume hospitals, by selecting surgeons who perform the operations frequently.
Media in This Article
Figure 1
Adjusted Operative Mortality among Medicare Patients in 1998 and 1999, According to Surgeon-Volume Stratum, for Four Cardiovascular Procedures (Panel A) and Four Cancer Resections (Panel B).Figure 2
Adjusted Operative Mortality among Medicare Patients in 1998 and 1999, According to Hospital-Volume Stratum and Surgeon-Volume Stratum for Four Cardiovascular Procedures (Panel A) and Four Cancer Resections (Panel B).Article Activity
- Article
For many surgical procedures, patients at hospitals where a high number of such procedures are performed (high-volume hospitals) have lower mortality rates than those at hospitals that are less experienced with the procedures.1-4 In one recent study of the national population of Medicare recipients, we found strong relations between hospital volume and operative mortality associated with 14 high-risk cancer resections and cardiovascular procedures.5 Despite the considerable body of research in this area, little is known about the mechanisms underlying the observed associations between volume and outcome. Because they tend to be much larger facilities, high-volume hospitals have a broader range of specialist and technology-based services, better-staffed intensive care units, and other resources that are not available at smaller centers. By virtue of these resources, high-volume hospitals may be better equipped to deliver the complex perioperative care required by patients who are undergoing high-risk surgery.
On the other hand, the outcome of a surgical procedure may depend as much on how well the operation itself is performed as on the resources available at the hospital. If so, another explanation for the observed relation between the hospital volume and the outcome may be that high-volume hospitals tend to have surgeons who are more experienced with specific procedures. Numerous studies have explored the associations between surgeon volume (the number of procedures performed by the surgeon) and mortality for some procedures.1,6-12 However, relatively few of these analyses have simultaneously accounted for hospital volume and other potential confounding characteristics of the hospital that may be strongly correlated with surgeon volume. Moreover, few have been large enough to characterize the relative influence of these two measures of volume with sufficient precision.
To address these issues, we undertook a comprehensive evaluation of the operative risk associated with eight different cardiovascular procedures and cancer resections using data from the national population of Medicare recipients. We had two primary aims: to assess the association between surgeon volume and operative mortality for various procedures and to achieve a better understanding of the extent to which the observed effects of hospital volume can be explained by the experience of the operating surgeon.
Methods
Patients and Data Bases
We obtained 100 percent of the national analytic files from the Center for Medicare and Medicaid Services for 1998 and 1999. The Medicare Provider Analysis and Review (MEDPAR) and inpatient files, which contain hospital-discharge abstracts for the fee-for-service, acute care hospitalizations of all Medicare recipients, were used to create our main data sets for analysis; the Medicare denominator file was used to determine the vital status of the patients. The institutional review board of Dartmouth Medical School approved the study protocol.
As in our previous work,5,13,14 we used the appropriate procedure codes from the International Classification of Diseases, Ninth Revision (ICD-9), to identify all patients between 65 and 99 years of age who underwent 1 of 14 cardiovascular procedures or cancer resections. To simplify the presentation of our results, however, we present here the analyses for only four cardiovascular procedures and four cancer resections. These procedures, which were selected prospectively, included two that are frequently the focus of debate concerning the regionalization of health care services (coronary-artery bypass grafting and carotid endarterectomy). Six other procedures (aortic-valve replacement, elective repair of an abdominal aortic aneurysm, pancreatic resection, esophagectomy, lung resection, and cystectomy) for which we have previously found a relatively strong association between hospital volume and operative mortality were selected to represent diverse surgical subspecialties.
In examining the data related to the cancer resections, we excluded from the analysis of outcomes (but not from the tallies of volume) patients who did not have an accompanying diagnosis code for cancer. This restriction was intended to exclude small subgroups of patients who had a much higher level of risk at base line (e.g., patients who underwent pancreatic resection because of infection) and thus to minimize confounding. Similarly, patients who underwent repair of an abdominal aortic aneurysm were excluded if they had diagnosis or procedure codes suggesting the rupture of an aneurysm, the presence of a thoracoabdominal aneurysm, or both. We excluded from the analysis of the cohort that underwent coronary-artery bypass grafting patients who had a valve replaced simultaneously.
Identification of Surgeons
For all procedures, we identified the operating surgeon with the use of the unique provider identification number listed in the “primary operator” field of the inpatient file. Previous work has suggested the reliability of this approach in identifying operating surgeons.15 Records containing invalid provider identification numbers (6 percent) were excluded from further analysis. For some procedures, the number of unique, valid identification numbers exceeded the number of surgeons in the relevant specialties in the United States. This problem was most apparent in the analysis of the two cardiac procedures, for which cardiologists were often identified in the primary-operator field. For this reason, we used information from the 1998 Medicare provider files to restrict our analysis to physicians who had designated themselves as surgeons. For coronary-artery bypass grafting and valve-replacement procedures, we included only self-designated cardiothoracic surgeons. Because the specialists who perform the other procedures are more diverse, we included any self-designated surgeon. These restrictions removed a large proportion of potentially eligible surgeons from our analysis (ranging from 6 percent for cystectomy to 72 percent for coronary-artery bypass grafting). However, because the physicians who were excluded tended to be associated with relatively few patients (most often only one each), the restrictions resulted in the exclusion of a relatively low proportion of patients from our analysis of outcomes (ranging from 4 percent for cystectomy to 13 percent for coronary-artery bypass grafting).
Statistical Analysis
Our primary analyses focused on the relations between surgeon volume and hospital volume (the main variables measuring exposure) and operative mortality, defined as death before hospital discharge or within 30 days after the index procedure. Because, for some procedures, a large proportion of operative deaths before discharge occurred more than 30 days after surgery, 30-day mortality alone would not adequately reflect the true operative mortality.
To characterize volume, we first determined the average number of procedures that each hospital and each surgeon performed on Medicare patients during each of the two years. To make our estimates of volume more easily interpretable, we then estimated the total (all-payer) volumes, using data from the 1997 Nationwide Inpatient Sample. As in our previous research,5 we determined the proportion of patients undergoing each procedure who were covered by Medicare — which ranged from 49 percent for esophagectomy to 75 percent for carotid endarterectomy — and divided each provider's observed Medicare volume (the total number of each type of procedure performed on Medicare patients) by these procedure-specific proportions. Although volume was evaluated as a continuous (log-transformed) variable in the assessment of statistical significance, we also created categorical variables for volume by ranking providers in order of increasing estimated total volume and selecting cutoff points that most closely sorted patients into three evenly sized groups with low, medium, and high volume. In sensitivity analyses, we recategorized hospital volume as a binary variable according to the criteria established by the Leapfrog Group for four procedures: coronary-artery bypass grafting (450 or more procedures per year vs. fewer than 450), repair of abdominal aortic aneurysm (50 or more per year vs. fewer than 50), esophagectomy (13 or more per year vs. fewer than 13), and pancreatic resection (11 or more per year vs. fewer than 11).
We used multiple logistic-regression analyses to examine the relation between surgeon volume and operative mortality, with adjustment for characteristics of the patients.16 We used the patient as the unit of analysis, with volume measured at the level of the surgeon and at the level of the hospital. All models were analyzed separately for each procedure. Separate models were used to investigate the relation between operative mortality and surgeon volume, with and without consideration of hospital volume, and the relation between operative mortality and hospital volume, with and without consideration of surgeon volume. To establish the general form of the relation, we first modeled the relations between operative mortality and the logarithms of surgeon volume and hospital volume considered separately. We then fitted the models to the three volume strata. We adjusted for the effect of clustering of patients within surgeons and clustering of surgeons within hospitals by using binary mixed-effects models incorporating the two levels of nesting.17 Surgeons who operated in more than one hospital were assumed to be in different clusters and contributed a random effect for each hospital in which they worked. We used the statistical software package MLwiN (Centre for Multilevel Modeling) to perform all modeling.18
We adjusted the analyses for characteristics of both the patients and the hospitals. The characteristics of the patients for which we adjusted included age group (in five-year intervals), sex, race (black or nonblack), year of procedure (1998 or 1999), whether the procedure was performed electively or not, and the mean income from Social Security in the ZIP Code of the patient's residence. Coexisting conditions were identified by their appropriate ICD-9 codes, with the exclusion of conditions that were likely to reflect either the primary indication for surgery or postoperative complications.5 We explored three alternative approaches to the incorporation of data on coexisting conditions into our models for risk adjustment, including the use of Charlson scores with published weights,19 the use of Charlson scores with weights derived empirically for each procedure, and adjustment for all pertinent coexisting conditions as individual variables. Because all three approaches yielded virtually identical results, we report only those from the models derived according to the first approach. We used 1998 and 1999 files from the American Hospital Association to ascertain the characteristics of the hospitals specific to the year in which the event occurred. The characteristics of the hospitals for which we adjusted included the type of ownership (not-for-profit, for-profit, or government), location (urban or nonurban), and teaching status (as defined by Taylor et al.20).
We computed adjusted mortality rates on the basis of the average values of the characteristics of the patients and the hospitals by back-transforming predicted mortality from the logistic-regression models. To assess the relative contribution of surgeon volume to the observed associations between hospital volume and outcome, we used models that estimated the relation between the operative mortality and hospital volume, first excluding and then including a variable for surgeon volume. The relative attenuation of the odds ratio was computed as [ORH–ORHS] ÷ [ORH–1], where ORH is the odds ratio for operative death with a given hospital volume without consideration of surgeon volume and ORHS is the odds ratio for operative death with a given hospital volume after adjustment for surgeon volume; both odds ratios were adjusted for patient characteristics and other characteristics of the hospital. A P value of less than 5 percent was considered to indicate statistical significance, and all tests were two-sided.
Results
A total of 474,108 Medicare patients underwent one of the eight cardiac procedures or cancer resections during 1998 or 1999. Overall, approximately 25 percent of the surgeons who were included in the study operated at more than one hospital. Patients were much more likely to undergo surgery performed by a low-volume surgeon if they went to a low-volume hospital (range, 51 percent for carotid endarterectomy to 70 percent for pancreatic resection) than if they went to a high-volume hospital (range, 6 percent for pancreatic resection to 21 percent for carotid endarterectomy). The numbers of Medicare patients treated by low-volume, medium-volume, and high-volume surgeons in different hospital-volume strata are given in Supplementary Appendix 1 (available with the full text of this article at www.nejm.org).
There were negligible differences in age and sex between the patients who received care from low-volume surgeons and those who received care from high-volume surgeons; for some procedures, the prevalence of coexisting conditions varied to a small degree according to surgeon volume (Table 1Table 1
Characteristics of the Patients, According to Surgeon Volume.). Patients receiving care from low-volume surgeons were more likely to be black and to be admitted to the hospital nonelectively. Overall, however, there were no clinically important differences in predicted mortality rates according to surgeon volume.When surgeon volume was assessed as a continuous variable, it was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The strength of the inverse association between surgeon volume and outcome varied markedly according to the procedure in terms of both the absolute operative mortality rate (Figure 1Figure 1
Adjusted Operative Mortality among Medicare Patients in 1998 and 1999, According to Surgeon-Volume Stratum, for Four Cardiovascular Procedures (Panel A) and Four Cancer Resections (Panel B).) and the adjusted odds ratio for operative death (Table 2Table 2
Adjusted Odds Ratio for Operative Death, According to Surgeon Volume and Hospital Volume.). The adjusted odds ratios for operative death among patients of low-volume surgeons as compared with patients of high-volume surgeons ranged from 1.24 for lung resection to 3.61 for pancreatic resection. Adjusting for hospital volume attenuated the strength of the associations between surgeon volume and outcome, but the effect of surgeon volume remained statistically significant for seven of the eight procedures.When hospital volume was assessed as a continuous variable, it was inversely related to operative mortality for seven of the eight procedures (P=0.20 for carotid endarterectomy, P<0.001 for all the other procedures). After adjustment for surgeon volume, however, higher hospital volume remained a significant predictor of decreased mortality for only four procedures (repair of an abdominal aortic aneurysm, cystectomy, lung resection, and pancreatic resection). In fact, after adjustment for surgeon volume, high hospital volume was associated with increased mortality among patients undergoing carotid endarterectomy. For many procedures, surgeon volume accounted for a large proportion of the apparent differences in operative mortality between high-volume hospitals and low-volume hospitals. Among patients undergoing elective repair of an abdominal aortic aneurysm, for example, the adjusted odds ratio for death with surgery performed in a low-volume hospital as compared with that performed in a high-volume hospital decreased from 1.40 to 1.17 after adjustment for surgeon volume. Thus, surgeon volume accounted for 57 percent of the apparent difference in mortality between low-volume and high-volume hospitals ([1.40–1.17] ÷ [1.40–1.00]). The proportion of the apparent effect of hospital volume that was actually attributable to surgeon volume varied according to the procedure: it was 100 percent for aortic-valve replacement, 54 percent for pancreatic resection, 49 percent for coronary-artery bypass grafting, 46 percent for esophagectomy, 39 percent for cystectomy, and 24 percent for lung resection.
Figure 2Figure 2
Adjusted Operative Mortality among Medicare Patients in 1998 and 1999, According to Hospital-Volume Stratum and Surgeon-Volume Stratum for Four Cardiovascular Procedures (Panel A) and Four Cancer Resections (Panel B). shows the relative effects of hospital volume and surgeon volume in terms of adjusted mortality rates. For carotid endarterectomy and aortic-valve replacement, the mortality rates decreased with increasing surgeon volume but did not change substantially with increasing hospital volume. Conversely, for lung resection, the adjusted mortality rates were strongly inversely related to hospital volume, but were less strongly related to surgeon volume. For the remaining five procedures, operative mortality decreased to relatively similar degrees with increasing hospital volume and increasing surgeon volume. Even within the high-volume–hospital stratum, the patients who received their care from low-volume surgeons had considerably higher mortality rates with several procedures than the patients who received care from high-volume surgeons.We performed similar sensitivity analyses using the hospital-volume criteria that were established by the Leapfrog Group for four of the procedures (Table 3Table 3
Adjusted Operative Mortality Rates among Medicare Patients in 1998 and 1999, According to Total Hospital Volume, Relative to the Leapfrog Group Volume Criteria and Surgeon Volume.). High-volume hospitals (those with volumes at or above the Leapfrog cutoffs) had lower overall mortality rates than low-volume hospitals, largely because patients at high-volume hospitals were much more likely to be treated by high-volume surgeons than by low-volume surgeons. For coronary-artery bypass grafting, elective repair of an abdominal aortic aneurysm, and esophagectomy, the operative mortality among the patients treated by low-volume surgeons at high-volume hospitals was higher than the overall operative mortality at low-volume hospitals. For pancreatic resection, patients at high-volume hospitals had lower mortality rates than those at low-volume hospitals, regardless of the surgeon volume.Discussion
By virtue of the large size and generalizability of the national Medicare data base, we were able to examine with precision the associations between surgeon volume and operative mortality for a wide range of cardiovascular procedures and cancer resections. For all eight procedures we studied, the patients treated by high-volume surgeons had lower operative mortality rates than those treated by low-volume surgeons. Surgeon volume accounted for a relatively large proportion of the apparent effect of hospital volume, to a degree that varied according to the procedure. For some procedures, the association between hospital volume and outcome disappeared almost entirely after surgeon volume had been taken into account.
It is not surprising that the relative importance of surgeon volume and hospital volume varies according to the procedure. In the case of carotid endarterectomy, for example, technical skill and the use of specific intraoperative processes (e.g., intraarterial shunt insertion and patch angioplasty)21 — processes used at the discretion of the operating surgeon — are important determinants of the risk of operative stroke or death. In contrast, other hospital-based services are relatively less important. Most patients undergoing carotid endarterectomy do not require intensive postoperative management, and the length of stay is typically just overnight. For these reasons, the preeminent role of surgeon volume in the outcome of this procedure has strong intuitive validity. In the case of lung resection, in contrast, patients rarely die because of direct technical complications of the procedure itself (e.g., bleeding or leakage from a bronchial stump); they die from cardiac events, pneumonia, and respiratory failure. Hospital-based services (e.g., intensive care, pain management, respiratory care, and nursing care) are very important, and the average length of stay is relatively long. Thus, it is not surprising that hospital volume was more important than surgeon volume in determining the outcome of this procedure. Of course, these two procedures represent the extremes. As suggested by our analysis, factors related to both surgeon volume and hospital volume seem to be important for most high-risk procedures.
Our study has several important limitations. First, because we used Medicare data, our study was restricted to patients 65 years of age or older. However, the elderly constitute the majority of patients undergoing the cardiovascular procedures and cancer resections that we examined in this study. Second, although our study was large, some of our subgroup analyses were based on relatively small numbers of patients. In particular, the number of patients who underwent procedures performed by low-volume surgeons at high-volume hospitals or by high-volume surgeons at low-volume hospitals was relatively low. Thus, estimates of mortality in these subgroups are relatively imprecise. Third, because of errors in the coding and assignment of unique provider identification numbers, we may have incorrectly identified the operating surgeon for some procedures. Such errors, if largely random, would tend to bias our results toward the null hypothesis (no effect of surgeon volume on outcome). However, to reduce any potential bias against low-volume surgeons, we excluded physicians who were not self-designated as surgeons.
Finally, many would question our ability to perform adequate risk adjustment with the use of administrative data.22,23 Whether risk adjustment is important in studies of surgical volume and outcome is uncertain. Some have noted that analyses based on clinical studies are less likely to report statistically significant associations between volume and outcome than those (the majority) that are based on administrative data.4 However, clinical studies also tend to be substantially smaller and often lack sufficient statistical power to detect clinically meaningful differences in operative mortality rates. Moreover, there is little evidence from clinical studies that there are important, volume-related differences in case mix (i.e., that low-volume providers care for “sicker” patients). Although we cannot rule out confounding by unmeasured characteristics of the patients in our study, there is no reason to believe that such confounding would affect our analyses of hospital volume and surgeon volume disproportionately. Thus, we do not believe that limitations related to risk adjustment threaten our main conclusions about the relative importance of hospital volume and surgeon volume.
Our findings have direct implications for ongoing initiatives for volume-based referral. Leading the most visible of these initiatives, the Leapfrog Group, a coalition of more than 140 large public and private purchasers, has established “evidence-based hospital referral” standards for several surgical procedures.24 Although the Leapfrog Group has recently incorporated data on outcomes and selected process measures into its 2003 standards for some procedures, criteria based on minimal hospital volume remain in place for coronary-artery bypass grafting, percutaneous coronary interventions, elective repair of an abdominal aortic aneurysm, esophagectomy, and pancreatic resection. Our analysis confirms that hospitals that exceed the volume criteria set by Leapfrog have lower mortality rates, on average, than those that do not. However, our findings also suggest that high-volume hospitals have better outcomes in large part because patients at these hospitals are more likely to be treated by high-volume surgeons and that standards based on surgeon volume as well as hospital volume would be more useful in directing patients to the providers who are likely to achieve the best outcomes. Increasing surgeons' volumes would require that administrators and leaders in the field of surgery actively manage the way in which selected operations are distributed within their hospitals — that is, by restricting them to a smaller number of surgeons. Although such efforts would no doubt encounter resistance, they may be more practical and less controversial than policies focusing exclusively on redistributing patients among hospitals.
We should also look for opportunities to improve the quality of surgical care delivered by low-volume surgeons. Determining whether this goal is realistic will require a better understanding of the mechanisms underlying the observed associations between volume and outcome. The key mechanism could simply be “practice” — clinical judgment and technical skill that are achieved only by surgeons who perform a specific procedure with sufficient frequency. Before jumping to this conclusion, however, we must better understand which specific processes of care are most important to the success of various operations and the extent to which they can be exported to other surgeons or hospitals.
Supported by a grant (R01 HS10141-01) from the Agency for Healthcare Research and Quality.
The views expressed in this article are those of the authors and do not necessarily represent those of the Center for Medicare and Medicaid Services or the U.S. government.
Dr. Birkmeyer reports serving as a paid consultant for the Leapfrog Group and as the chair of its advisory panel on evidence-based hospital referral.
Source Information
From the Department of Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, N.H. (J.D.B., P.P.G.); the Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vt. (J.D.B., P.P.G.); the Institute for Clinical Evaluative Sciences, Toronto (T.A.S.); and the Center for Outcomes Research and Evaluation, Maine Medical Center, Portland (A.E.S., D.E.W., F.L.L.).
Address reprint requests to Dr. Birkmeyer at the Section of General Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756, or at john.birkmeyer@hitchcock.org.
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Hideo Yasunaga, Kazuaki Tsuchiya, Yutaka Matsuyama, Kazuhiko Ohe. (2009) High-volume surgeons in regard to reductions in operating time, blood loss, and postoperative complications for total hip arthroplasty. Journal of Orthopaedic Science 14:1, 3-9
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Jesús Gil-Bona, Antoni Sabaté, Albert Pi, Romà Adroer, Eduardo Jaurrieta. (2009) Mortality risk factors in surgical patients in a tertiary hospital: a study of patient records in the period 2004–2006. Cirugía Española (English Edition) 85:4, 229-237
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Attila Dubecz, Daniela Molena, Jeffrey H. Peters. (2008) Modern Surgery for Esophageal Cancer. Gastroenterology Clinics of North America 37:4, 965-987
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John E. Scarborough, Ricardo Pietrobon, Bryan M. Clary, Carlos E. Marroquin, Kyla M. Bennett, Paul C. Kuo, Theodore N. Pappas. (2008) Regionalization of Hepatic Resections Is Associated with Increasing Disparities among Some Patient Populations in Use of High-Volume Providers. Journal of the American College of Surgeons 207:6, 831-838
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Joaquín Sanchis. (2008) ¿Cuanto más azúcar, más dulce?. Archivos de Bronconeumología 44:11, 584-585
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David W. Larson, Peter W. Marcello, Sergio W. Larach, Steven D. Wexner, Adrian Park, John Marks, Anthony J. Senagore, Alan G. Thorson, Tonia M. Young-Fadok, Erin Green, Daniel J. Sargent, Heidi Nelson. (2008) Surgeon Volume Does Not Predict Outcomes in the Setting of Technical Credentialing. Annals of Surgery 248:5, 746-750
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Julia H. Rowland. (2008) What Are Cancer Survivors Telling Us?. The Cancer Journal 14:6, 361-368
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Dae Hyun Kim, Constantine Daskalakis, Andrew N. Lee, Suzanne Adams, Sam Hohmann, Scott C. Silvestry, Sofia Medvedev, David J. Whellan. (2008) Racial Disparity in the Relationship Between Hospital Volume and Mortality Among Patients Undergoing Coronary Artery Bypass Grafting. Annals of Surgery 248:5, 886-892
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Michelle A. Aranda, Marcia McGory, Evan Sekeris, Melinda Maggard, Clifford Ko, David S. Zingmond. (2008) Do racial/ethnic disparities exist in the utilization of high-volume surgeons for women with ovarian cancer?. Gynecologic Oncology 111:2, 166-172
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Philip P. Goodney, Donald S. Likosky, Jack L. Cronenwett. (2008) Factors associated with stroke or death after carotid endarterectomy in Northern New England. Journal of Vascular Surgery 48:5, 1139-1145
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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
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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
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Brian R. Smith, Marcelo W. Hinojosa, Kevin M. Reavis, Ninh T. Nguyen. (2008) Outcomes of Esophagectomy According to Surgeon’s Training: General vs. Thoracic. Journal of Gastrointestinal Surgery 12:11, 1907-1911
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Kenneth K. Wang. (2008) Selecting Treatment for Barrett's Esophagus: No Second Chances to Make a First Impression. Clinical Gastroenterology and Hepatology 6:11, 1181-1182
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Massimo Falconi, Stefano Crippa, Ismael Domínguez, Giuliano Barugola, Paola Capelli, Stefano Marcucci, Stefania Beghelli, Aldo Scarpa, Claudio Bassi, Paolo Pederzoli. (2008) Prognostic Relevance of Lymph Node Ratio and Number of Resected Nodes after Curative Resection of Ampulla of Vater Carcinoma. Annals of Surgical Oncology 15:11, 3178-3186
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Martin Sundelöf, Jesper Lagergren, Weimin Ye. (2008) Surgical Factors Influencing Outcomes in Patients Resected for Cancer of the Esophagus or Gastric Cardia. World Journal of Surgery 32:11, 2357-2365
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Patrick Yachimski, Norman S. Nishioka, Ethan Richards, Chin Hur. (2008) Treatment of Barrett's Esophagus With High-Grade Dysplasia or Cancer: Predictors of Surgical Versus Endoscopic Therapy. Clinical Gastroenterology and Hepatology 6:11, 1206-1211
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George N. Thalmann, John P. Stein. (2008) Outcomes of radical cystectomy. BJU International 102:9b, 1279-1288
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Wendy R. Brewster. (2008) The complexity of race in the disparate outcome and treatment of minority patients. Gynecologic Oncology 111:2, 161-162
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Hendrik Manner, Andrea May, Oliver Pech, Liebwin Gossner, Thomas Rabenstein, Erwin Günter, Michael Vieth, Manfred Stolte, Christian Ell. (2008) Early Barrett's Carcinoma With “Low-Risk” Submucosal Invasion: Long-Term Results of Endoscopic Resection With a Curative Intent. The American Journal of Gastroenterology 103:10, 2589-2597
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Alberto Briganti, Umberto Capitanio, Felix K.-H. Chun, Andrea Gallina, Nazareno Suardi, Andrea Salonia, Luigi F. Da Pozzo, Renzo Colombo, Valerio Di Girolamo, Roberto Bertini, Giorgio Guazzoni, Pierre I. Karakiewicz, Francesco Montorsi, Patrizio Rigatti. (2008) Impact of Surgical Volume on the Rate of Lymph Node Metastases in Patients Undergoing Radical Prostatectomy and Extended Pelvic Lymph Node Dissection for Clinically Localized Prostate Cancer. European Urology 54:4, 794-804
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Robert W. Eppsteiner, Nicholas G. Csikesz, Jessica P. Simons, Jennifer F. Tseng, Shimul A. Shah. (2008) High Volume and Outcome After Liver Resection: Surgeon or Center?. Journal of Gastrointestinal Surgery 12:10, 1709-1716
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Eric S. Weiss, Robert A. Meguid, Nishant D. Patel, Stuart D. Russell, Ashish S. Shah, William A. Baumgartner, John V. Conte. (2008) Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change?. The Annals of Thoracic Surgery 86:4, 1250-1260
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P. Schräder, O. Boy, W. Schleiz, R. Dienst, C. Reinert, V. Sänger, H.-H. Schauwecker, W. Siebert, H.-P. Scharf. (2008) Indikationsstellung in der primären Hüft- und Kniegelenkendoprothetik. Der Orthopäde 37:10, 1016-1026
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Joan Figueras, Antonio Codina-Barreras, Santiago López-Ben, Laia Falgueras, Héctor Daniel González, Maite Albiol, Jordi Soriano, Montserrat Figa, Berta Pardina, Fernando González-Huix, Albert Maroto, Antonio Codina-Cazador. (2008) Resultados de la cirugía hepatobiliopancreática en un servicio de cirugía de un hospital de segundo nivel según los GRD durante el bienio 2005-2006. Cirugía Española 84:3, 146-153
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Martin Rutegård, Pernilla Lagergren. (2008) No Influence of Surgical Volume on Patients’ Health-Related Quality of Life After Esophageal Cancer Resection. Annals of Surgical Oncology 15:9, 2380-2387
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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
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Sandra L. Wong, Laurence E. McCahill, Stephen B. Edge, Robert L. Askew, Peter D. Beitsch, Daniel R. Kollmorgen, Thomas Anthony, Nicholas J. Petrelli, Stanley P. L. Leong, Janice N. Cormier. (2008) Getting to Better Cancer Care: Results of a Society of Surgical Oncology Survey. Annals of Surgical Oncology 15:9, 2363-2371
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Peter B. Bach. (2008) Do Surgical Quality Gaps Cause Healthcare Disparities?. Medical Care 46:9, 889-892
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Hari Nathan, Wayne Frederick, Michael A. Choti, Richard D. Schulick, Timothy M. Pawlik. (2008) Racial Disparity in Surgical Mortality after Major Hepatectomy. Journal of the American College of Surgeons 207:3, 312-319
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John E. Scarborough, Ricardo Pietrobon, Janet E. Tuttle-Newhall, Carlos E. Marroquin, Bradley H. Collins, Dev M. Desai, Paul C. Kuo, Theodore N. Pappas. (2008) Relationship Between Provider Volume and Outcomes For Orthotopic Liver Transplantation. Journal of Gastrointestinal Surgery 12:9, 1527-1533
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Maurie Markman. (2008) Assigning a cause for a particular outcome in oncology. Cancer 113:4, 668-670
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Hideo Yasunaga, Hitoshi Yanaihara, Kohzo Fuji, Yutaka Matsuyama, Nobuhiro Deguchi, Kazuhiko Ohe. (2008) Influence of hospital and surgeon volumes on operative time, blood loss and perioperative complications in radical nephrectomy. International Journal of Urology 15:8, 688-693
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Nasser K. Altorki, Xi Kathy Zhou, Brendon Stiles, Jeffrey L. Port, Subroto Paul, Paul C. Lee, Madhu Mazumdar. (2008) Total Number of Resected Lymph Nodes Predicts Survival in Esophageal Cancer. Annals of Surgery 248:2, 221-226
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Juan C. Gutierrez, Judith D. Hurley, Nadine Housri, Eduardo A. Perez, Margaret M. Byrne, Leonidas G. Koniaris. (2008) Are Many Community Hospitals Undertreating Breast Cancer?. Annals of Surgery 248:2, 154-162
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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
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Susanna M. Nazarian, Gayane Yenokyan, Richard E. Thompson, Michael E. Griswold, David C. Chang, Bruce A. Perler. (2008) Statistical modeling of the volume-outcome effect for carotid endarterectomy for 10 years of a statewide database. Journal of Vascular Surgery 48:2, 343-350
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Daniel Herzig. (2008) THE VOLUME-OUTCOME RELATIONSHIP: DOES IT APPLY TO THE SURGICAL TREATMENT OF ULCERATIVE COLITIS?. Evidence-Based Gastroenterology 9:3, 43-44
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Brian Santin, Aaron Kulwicki, Phillip Price. (2008) Mortality Rate Associated with 56 Consecutive Esophagectomies Performed at a “Low-Volume” Hospital: is Procedure Volume as Important as We are Trying to Make it?. Journal of Gastrointestinal Surgery 12:8, 1346-1350
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Ganapathy A. Prasad, Kenneth K. Wang, Kevin C. Halling, Navtej S. Buttar, Louis-Michel Wongkeesong, Alan R. Zinsmeister, Shannon M. Brankley, Wytske M. Westra, Lori S. Lutzke, Lynn S. Borkenhagen, Kelly Dunagan. (2008) Correlation of histology with biomarker status after photodynamic therapy in Barrett esophagus. Cancer 113:3, 470-476
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J. Gregory Modrall, Eric B. Rosero, Stephen T. Smith, Frank R. Arko, R. James Valentine, G. Patrick Clagett, Carlos H. Timaran. (2008) Operative mortality for renal artery bypass in the United States: Results from the National Inpatient Sample. Journal of Vascular Surgery 48:2, 317-322.e1
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Vivian Ho, Thomas Aloia. (2008) Hospital Volume, Surgeon Volume, and Patient Costs for Cancer Surgery. Medical Care 46:7, 718-725
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Antonio M. Lacy, Salvadora Delgado, Antoni Castells, Hubert A. Prins, Vicente Arroyo, Ainitze Ibarzabal, Josep M. Pique. (2008) The Long-term Results of a Randomized Clinical Trial of Laparoscopy-assisted Versus Open Surgery for Colon Cancer. Annals of Surgery 248:1, 1-7
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Jae-Sung Cho, Jang Yong Kim, Robert Y. Rhee, NavYash Gupta, Luke K. Marone, Ellen D. Dillavou, Michel S. Makaroun. (2008) Contemporary results of open repair of ruptured abdominal aortoiliac aneurysms: Effect of surgeon volume on mortality. Journal of Vascular Surgery 48:1, 10-18
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Elzbieta Bednarska, Dianne Bryant, P. J. Devereaux, . (2008) Orthopaedic Surgeons Prefer to Participate in Expertise-based Randomized Trials. Clinical Orthopaedics and Related Research 466:7, 1734-1744
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Chiara Pierantoni, Alessandra Pagliacci, Mario Scartozzi, Rossana Berardi, Maristella Bianconi, Stefano Cascinu. (2008) Pancreatic cancer: Progress in cancer therapy. Critical Reviews in Oncology/Hematology 67:1, 27-38
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Shabbir M.H. Alibhai, Marc Leach, George Tomlinson. (2008) Impact of Hospital and Surgeon Volume on Mortality and Complications After Prostatectomy. The Journal of Urology 180:1, 155-163
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Chung-Shu Lin, Hsin-Chien Lee, Chen-Tong Lin, Herng-Ching Lin. (2008) The Association between Surgeon Case Volume and Hospitalization Costs in Free Flap Oral Cancer Reconstruction Operations. Plastic and Reconstructive Surgery 122:1, 133-139
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David K Chang, Neil D Merrett, Andrew V Biankin, . (2008) Improving outcomes for operable pancreatic cancer: Is access to safer surgery the problem?. Journal of Gastroenterology and Hepatology 23:7pt1, 1036-1045
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Justin B. Dimick, Gilbert R. Upchurch. (2008) Endovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery. Journal of Vascular Surgery 47:6, 1150-1154
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Ananya Das, Vandana Singh, David E. Fleischer, Virender K. Sharma. (2008) A Comparison of Endoscopic Treatment and Surgery in Early Esophageal Cancer: An Analysis of Surveillance Epidemiology and End Results Data. The American Journal of Gastroenterology 103:6, 1340-1345
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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
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Brent K. Hollenbeck, Rodney L. Dunn, Scott M. Gilbert, Seth Strope, David C. Miller. (2008) Effects of Laparoscopy on Surgical Discharge Practice Patterns. Urology 71:6, 1029-1034
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Eric A. Klein, Fernando J. Bianco, Angel M. Serio, James A. Eastham, Michael W. Kattan, J. Edson Pontes, Andrew J. Vickers, Peter T. Scardino. (2008) Surgeon Experience is Strongly Associated With Biochemical Recurrence After Radical Prostatectomy for All Preoperative Risk Categories. The Journal of Urology 179:6, 2212-2217
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Álvaro Díaz De Liaño, Concepción Yarnoz, Rubén Aguilar, Cristina Artieda, Héctor Ortiz. (2008) Rationale for gastrectomy with D2 lymphadenectomy in the treatment of gastric cancer. Gastric Cancer 11:2, 96-102
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Noboru Hara, Yasuo Kitamura, Toshihiro Saito, Shuichi Komatsubara, Tsutomu Nishiyama, Kota Takahashi. (2008) Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: Efficacy and risk of antimicrobial prophylaxis on the operation day alone. International Journal of Urology 15:6, 511-515
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Paweł Lampe, Katarzyna Kuśnierz. (2008) Comments on the Selected Problems in Surgery of the Pancreas. Polish Journal of Surgery 80:6, 295-298
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Ju-Mei Ng. (2008) Perioperative Anesthetic Management for Esophagectomy. Anesthesiology Clinics 26:2, 293-304
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Joseph S. Carey, Joseph P. Parker, Claude Brandeau, Zhongmin Li. (2008) The “occasional open heart surgeon” revisited. The Journal of Thoracic and Cardiovascular Surgery 135:6, 1254-1260
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Kaoru R. Goshima, Joseph L. Mills, Kelly Awari, Steven Lee Pike, John D. Hughes. (2008) Measure What Matters: Institutional Outcome Data Are Superior to the Use of Surrogate Markers to Define “Center of Excellence” for Abdominal Aortic Aneurysm Repair. Annals of Vascular Surgery 22:3, 328-334
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Debasish Das, Savid Ishaq, Rebecca Harrison, Kiran Kosuri, Edward Harper, John deCaestecker, Richard Sampliner, Stephen Attwood, Hugh Barr, Peter Watson, Paul Moayyedi, Janusz Jankowski. (2008) Management of Barrett's Esophagus in the UK: Overtreated and Underbiopsied but Improved by the Introduction of a National Randomized Trial. The American Journal of Gastroenterology 103:5, 1079-1089
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L.L. Hoornweg, M.N. Storm-Versloot, D.T. Ubbink, M.J.W. Koelemay, D.A. Legemate, R. Balm. (2008) Meta Analysis on Mortality of Ruptured Abdominal Aortic Aneurysms. European Journal of Vascular and Endovascular Surgery 35:5, 558-570
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Wendy Siu, Stephanie Daignault, David C. Miller, Rodney L. Dunn, Scott Gilbert, Alon Z. Weizer, Zaojun Ye, Brent K. Hollenbeck. (2008) Understanding differences between high and low volume hospitals for radical prostatectomy. Urologic Oncology: Seminars and Original Investigations 26:3, 260-265
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Andrzej Cichocki, Mariusz Jóźwiak, Radosław Samsel, Paweł Piotrowski, Grzegorz Nawrocki, Katarzyna Roszkowska. (2008) Characterization of Tumors of the Pancreas and the Pancreatoduodenal Area in own Material, in 2-Year Prospective Observation. Polish Journal of Surgery 80:5, 233-240
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Martin Loos, Jörg Kleeff, Helmut Friess, Markus W. Büchler. (2008) Approaches to localized pancreatic cancer. Current Oncology Reports 10:3, 212-219
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David J. Biau, Raphaël Porcher, Isabelle Boutron. (2008) The account for provider and center effects in multicenter interventional and surgical randomized controlled trials is in need of improvement: a review. Journal of Clinical Epidemiology 61:5, 435-439
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Mark D. Stringer. (2008) Biliary atresia: service delivery and outcomes. Seminars in Pediatric Surgery 17:2, 116-122
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Fernando J. Bianco. (2008) Radical prostatectomy: Surgical planning, execution, and outcomes. Current Urology Reports 9:3, 231-236
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John E. Scarborough, Ricardo Pietrobon, Kyla M. Bennett, Bryan M. Clary, Paul C. Kuo, Douglas S. Tyler, Theodore N. Pappas. (2008) Workforce Projections for Hepato-Pancreato-Biliary Surgery. Journal of the American College of Surgeons 206:4, 678-684
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Bradley G. Hammill, Lesley H. Curtis, Elliott Bennett-Guerrero, Christopher M. OʼConnor, James G. Jollis, Kevin A. Schulman, Adrian F. Hernandez. (2008) Impact of Heart Failure on Patients Undergoing Major Noncardiac Surgery. Anesthesiology 108:4, 559-567
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A.J. Debes, R.H. Størkson, M.B. Jacobsen. (2008) Curative rectal cancer surgery in a low-volume hospital: A quality assessment. European Journal of Surgical Oncology (EJSO) 34:4, 382-389
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Chia-Cheng Lin, Herng-Ching Lin. (2008) Effects of surgeon and hospital volume on 5-year survival rates following oral cancer resections: The experience of an Asian country. Surgery 143:3, 343-351
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Vincent B. Nieuwenhuijs, John W. Chen, Libby John, John Ring, Hugh Harley, Paul M. Dolan, Robert T. A. Padbury. (2008) LIVER TRANSPLANTATION: A SMALL-VOLUME UNIT EXPERIENCE. ANZ Journal of Surgery 78:3, 128-133
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Nasser K. Altorki, Paul C. Lee, Yaakov Liss, Danish Meherally, Robert J. Korst, Paul Christos, Madhu Mazumdar, Jeffrey L. Port. (2008) Multifocal Neoplasia and Nodal Metastases in T1 Esophageal Carcinoma. Annals of Surgery 247:3, 434-439
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Alexander Rosemurgy, Sarah Cowgill, Brian Coe, Ashley Thomas, Sam Al-Saadi, Steven Goldin, Emmanuel Zervos. (2008) Frequency With Which Surgeons Undertake Pancreaticoduodenectomy Continues to Determine Length of Stay, Hospital Charges, and In-Hospital Mortality. Journal of Gastrointestinal Surgery 12:3, 442-449
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G. Balzano, A. Zerbi, G. Capretti, S. Rocchetti, V. Capitanio, V. Di Carlo. (2008) Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. British Journal of Surgery 95:3, 357-362
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Morgan L. Brown, Patricia A. Pellikka, Hartzell V. Schaff, Christopher G. Scott, Charles J. Mullany, Thoralf M. Sundt, Joseph A. Dearani, Richard C. Daly, Thomas A. Orszulak. (2008) The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis. The Journal of Thoracic and Cardiovascular Surgery 135:2, 308-315
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Andrew C. Chang, Hong Ji, Nancy J. Birkmeyer, Mark B. Orringer, John D. Birkmeyer. (2008) Outcomes After Transhiatal and Transthoracic Esophagectomy for Cancer. The Annals of Thoracic Surgery 85:2, 424-429
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James P. Marcin, Zhongmin Li, Richard L. Kravitz, Jian J. Dai, David M. Rocke, Patrick S. Romano. (2008) The CABG Surgery Volume-Outcome Relationship: Temporal Trends and Selection Effects in California, 1998-2004. Health Services Research 43:1p1, 174-192
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Brant K. Oelschlager, Elina Quiroga, Juan D. Parra, Mark Cahill, Nayak Polissar, Carlos A. Pellegrini. (2008) Long-Term Outcomes After Laparoscopic Antireflux Surgery. The American Journal of Gastroenterology 103:2, 280-287
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Helen Mabry, Armando E. Giuliano. (2008) SSO approved training programs in breast cancer care. Journal of Surgical Oncology 97:2, 99-100
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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
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Laurent G. Glance, Andrew Dick, Dana B. Mukamel, Yue Li, Turner M. Osler. (2008) Are High-Quality Cardiac Surgeons Less Likely to Operate on High-Risk Patients Compared to Low-Quality Surgeons? Evidence from New York State. Health Services Research 43:1p1, 300-312
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David Le, Shahzeer Karmali, Jay K. Harness, Brett C. Sheppard. (2008) An Update: The Operative Experience in Adrenal, Pancreatic, and Other Less Common Endocrine Diseases of U.S. General Surgery Residents. World Journal of Surgery 32:2, 232-236
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N. Pal, B. Axisa, S. Yusof, R. G. Newcombe, S. Wemyss-Holden, M. Rhodes, M. P. N. Lewis. (2008) Volume and Outcome for Major Upper GI Surgery in England. Journal of Gastrointestinal Surgery 12:2, 353-357
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Dan S. Zuckerman, David P. Ryan. (2008) Adjuvant therapy for pancreatic cancer. Cancer 112:2, 243-249
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Fred Perkins, Tabitha Washington. 2008. Preemptive Analgesia and Prevention of Chronic Pain Syndromes after Surgery. , 335-341.
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Hendrik Manner, Oliver Pech, Christian Ell. (2008) Endoskopische Resektion und Ablation beimÖsophaguskarzinom. Chirurgische Gastroenterologie 24:1, 23-32
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Hideo YASUNAGA, Yutaka MATSUYAMA, Kazuhiko OHE, The Japan Neurosurgical Society. (2008) Risk-Adjusted Analyses of the Effects of Hospital and Surgeon Volumes on Postoperative Complications and the Modified Rankin Scale After Clipping of Unruptured Intracranial Aneurysms in Japan. Neurologia medico-chirurgica 48:12, 531-538
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Christoph W. Michalski, Jörg Kleeff, Jeannine Bachmann, Jaber AlKhatib, Mert Erkan, Irene Esposito, Ulf Hinz, Helmut Friess, Markus W. Büchler. (2008) Second-Look Operation for Unresectable Pancreatic Ductal Adenocarcinoma at a High-Volume Center. Annals of Surgical Oncology 15:1, 186-192
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Oliver Pech, Thomas Rabenstein, Hendrik Manner, Maria C. Petrone, Jürgen Pohl, Michael Vieth, Manfred Stolte, Christian Ell. (2008) Confocal Laser Endomicroscopy for In Vivo Diagnosis of Early Squamous Cell Carcinoma in the Esophagus. Clinical Gastroenterology and Hepatology 6:1, 89-94
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Min-Ho Song, Yoshiyuki Tokuda, Tomohiro Nakayama, Keisuke Hattori, Masaya Hirai. (2008) Safe Launching of a Newly Appointed Cardiac Surgery Unit at a Low-Volume Hospital With the Use of Cumulative Sum Analysis. Circulation Journal 72:3, 437-440
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Brendan C. Visser, Rowan W. Parks, O. James Garden. (2008) Open cholecystectomy in the laparoendoscopic era. The American Journal of Surgery 195:1, 108-114
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Álvaro Díaz de Liaño, Concepción Yárnoz, Rubén Aguilar, Cristina Artieda, Héctor Ortiz. (2008) Morbilidad y mortalidad de la gastrectomía con linfadenectomía D2 en una unidad especializada. Cirugía Española 83:1, 18-23
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Nestor F. Esnaola, Bruce L. Hall, Patrick W. Hosokawa, John Z. Ayanian, William G. Henderson, Shukri F. Khuri, Michael J. Zinner, Selwyn O. Rogers. (2008) Race and Surgical Outcomes. Transactions of the ... Meeting of the American Surgical Association 126, 290-298
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Eric C. Feliberti, Roger R. Perry. (2007) Volume as a marker of surgical quality. Journal of Surgical Oncology 96:7, 539-540
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Véronique Veuillez, Philippe Rougier, Jean-François Seitz. (2007) Multimodal treatment of oesophageal cancer. Best Practice & Research Clinical Gastroenterology 21:6, 947-963
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Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliott L. Chaikof, Kirsten E. Fleischmann, William K. Freeman, James B. Froehlich, Edward K. Kasper, Judy R. Kersten, Barbara Riegel, John F. Robb, Sidney C. Smith, Alice K. Jacobs, Cynthia D. Adams, Jeffrey L. Anderson, Elliott M. Antman, Christopher E. Buller, Mark A. Creager, Steven M. Ettinger, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Sharon A. Hunt, Bruce W. Lytle, Rick Nishimura, Joseph P. Ornato, Richard L. Page, Barbara Riegel, Lynn G. Tarkington, Clyde W. Yancy. (2007) ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Journal of the American College of Cardiology 50:17, e159-e242
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P.J.E. Holt, J.A. Michaels. (2007) Does Volume Directly Affect Outcome in Vascular Surgical Procedures?. European Journal of Vascular and Endovascular Surgery 34:4, 386-389
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DOUGLAS F. ZATZICK, FREDERICK P. RIVARA, AVERY B. NATHENS, GREGORY J. JURKOVICH, JIN WANG, MING-YU FAN, JOAN RUSSO, DAVID S. SALKEVER, ELLEN J. MACKENZIE. (2007) A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychological Medicine 37:10,
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Andrew Judge, Simon Evans, David J. Gunnell, Peter C. Albertsen, Julia Verne, Richard M. Martin. (2007) Patient outcomes and length of hospital stay after radical prostatectomy for prostate cancer: analysis of Hospital Episodes Statistics for England. BJU International 0:0, 070907033641007-???
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Michael J. Englesbe, Shawn J. Pelletier, John C. Magee, Paul Gauger, Tracy Schifftner, William G. Henderson, Shukri F. Khuri, Darrell A. Campbell. (2007) Seasonal Variation in Surgical Outcomes as Measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Annals of Surgery 246:3, 456-465
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H.-H. Eckstein, T. Bruckner, P. Heider, O. Wolf, M. Hanke, H.-P. Niedermeier, T. Noppeney, T. Umscheid, H. Wenk. (2007) The Relationship Between Volume and Outcome Following Elective Open Repair of Abdominal Aortic Aneurysms (AAA) in 131 German Hospitals. European Journal of Vascular and Endovascular Surgery 34:3, 260-266
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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
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John J. Regan, Paul C. McAfee, Scott L. Blumenthal, Richard D. Guyer, Fred H. Geisler, Rolando Garcia, James H. Maxwell. (2006) Evaluation of Surgical Volume and the Early Experience With Lumbar Total Disc Replacement as Part of the Investigational Device Exemption Study of the Charit?? Artificial Disc. Spine 31:19, 2270-2276
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