Users' guide to the surgical literature: how to use an article reporting population-based volume-outcome relationships in surgery.

Abstract

In this era there is a close examination of the actions of health care institutions during the course of patient treatments and the actual patient outcomes that result. In the past, most attention centred on medical efficacy or the development of improved treatments through vehicles such as randomized clinical trials. While recognizing the continued importance of such efforts, the EAA also focuses on effectiveness or what actually happens when treatments are delivered to patients in the real world. A population-based volume‐outcomes study is one tool that can be used to gain understanding of the effectiveness of therapies in large groups of patients. Such studies use large databases and retrospective analyses to explore the relationship between treatment volume of procedures provided by hospitals and patient outcomes. Most published volume‐outcome studies show improved patient outcomes when treatment occurs in higher-volume centres. 2 Such findings often prompt researchers and policymakers to recommend regionalization of the examined procedure into larger-volume hospitals. There are already reports of regionalization of care occurring for certain surgical procedures such as coronary artery bypass surgery, 3,4