There has been much interest in the volume—outcome relationship within surgical specialities and the potential impact on service reconfiguration. Recent research has raised questions about the validity of the methodology used in existing volume—outcome studies. This review explores a methodological framework for assessing the volume—outcome relationship and discusses limitations of previous research. In particular reference is made to the existing urological literature in this field. Areas for improvement and the potential for future research are considered.
LuftHSBunkerJPEnthovenAC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med1979; 301: 1364–9.
ChristianCKGustafsonMLBetenskyRADaleyJZinnerMJ. The volume—outcome relationship: don't believe everything you see. World J Surg2005; 29: 1241–4.
4.
HalmEALeeCChassinMR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med2002; 137: 511–20.
5.
DonabedianA. Evaluating the quality of medical care. Milbank Memorial Fund Quart1966; 44: 166–203.
6.
HewittM. Interpreting the volume—outcome relationship in the context of health care quality: workshop summary. Institute of Medicine, Washington, DC: National Academic Press; 2000.
7.
HalmELeeCChassinM. How is volume related to quality in health care? A systematic review of the research literature. In: Interpreting the volume—outcome relationship in the context of health care quality: workshop summary. Institute of Medicine, Washington, DC: National Academic Press; 2000.
8.
KilleenSDO'SullivanMJCoffeyJCKirwanWORedmondHP. Provider volume and outcomes for oncological procedures. Br J Surg2005; 92: 389–402.
9.
PanageasKSSchragDRiedelEBachPBBeggCB. The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med2003; 139: 658–65.
10.
EllisonLMTrockBJPoeNRPartinAW. The effect of hospital volume on cancer control after radical prostatectomy. J Urol2005; 173: 2094–8.
AylinPBottleAMajeedA. Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ2007; 334: 1044.
13.
BirkmeyerJDStukelTASiewersAEGoodneyPPWennbergDELucasFL. Surgeon volume and operative mortality in the United States. N Engl J Med2003; 349: 2117–27.
14.
SchragDPanageasKSRiedelECramerLDGuillemJGBachPBHospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg2002; 236: 583–92.
15.
SchragDPanageasKSRiedelEHsiehLBachPBGuillemJGSurgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol2003; 83: 68–78 [discussion 78–9].
16.
BeggCBRiedelERBachPBKattanMWSchragDWarrenJLVariations in morbidity after radical prostatectomy. N Engl J Med2002; 346: 1138–44.
17.
BiancoFJJrRiedelERBeggCBKattanMWScardinoPT. Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol2005; 173: 2099–103.
18.
MasonAGoldacreMJBettleyGValeJJoyceA. Using routine data to define clinical case-mix and compare hospital outcomes in urology. BJU Int2006; 97: 1145–7.
19.
KonetyBRDhawanVAllareddyVJoslynSA. Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project. J Urol2005; 173: 1695–700.
20.
McCabeJEJibawiAJavleP. Defining the minimum hospital case-load to achieve optimum outcomes in radical cystectomy. BJU Int2005; 96: 806–10.
21.
HollenbeckBKWeiYBirkmeyerJD. Volume, process of care, and operative mortality for cystectomy for bladder cancer. Urology2007; 69: 871–5.
22.
EltingLSPettawayCBekeleBNGrossmanHBCooksleyCAvritscherEBCorrelation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study. Cancer2005; 104: 975–84.
23.
NelsonCPDunnRLWeiJTGearhartJP. Surgical repair of bladder exstrophy in the modern era: contemporary practice patterns and the role of hospital case volume. J Urol2005; 174: 1099–102.
24.
EasthamJAKattanMWRiedelEBeggCBWheelerTMGerigkCVariations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol2003; 170: 2292–5.
25.
YaoSLLu-YaoG. Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst1999; 91: 1950–6.
26.
HuJCGoldKFPashosCLMehtaSSLitwinMS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol2003; 21: 401–5.
27.
DavenportKTimoneyAGKeeleyFXJoyceADowneyP. A 3-year review of The British Association of Urological Surgeons Section of endourology laparoscopic nephrectomy audit. BJU Int2006; 97: 333–7.
28.
TaubDAMillerDCCowanJADimickJBMontieJEWeiJT. Impact of surgical volume on mortality and length of stay after nephrectomy. Urology2004; 63: 862–7.
29.
GoodneyPPStukelTALucasFLFinlaysonEVBirkmeyerJD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg2003; 238: 161–7.
30.
KonetyBRAllareddyVModakSSmithB. Mortality after major surgery for urologic cancers in specialized urology hospitals: are they any better?J Clin Oncol2006; 24: 2006–12.
31.
ThorpeACClearyRColesJVernonSReynoldsJNealDE. Deaths and complications following prostatectomy in 1400 men in the northern region of England. Northern Regional Prostate Audit Group. Br J Urol1994; 74: 559–65.
32.
HillnerBESmithTJDeschCE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol2000; 18: 2327–40.
33.
KonetyBRAllareddyVHerrH. Complications after radical cystectomy: analysis of population-based data. Urology2006; 68: 58–64.
34.
ChunFKBrigantiAAntebiEGraefenMCurrlinESteuberTSurgical volume is related to the rate of positive surgical margins at radical prostatectomy in European patients. BJU Int2006; 98: 1204–9.
35.
HollenbeckBKDaignaultSDunnRLGilbertSWeizerAZMillerDC. Getting under the hood of the volume—outcome relationship for radical cystectomy. J Urol2007; 177: 2095–9 [discussion 2099].
36.
JudgeAEvansSGunnellDJAlbertsenPCVerneJMartinRM. Patient outcomes and length of hospital stay after radical prostatectomy for prostate cancer: analysis of hospital episodes statistics for England. BJU Int2007; 100: 1040–9.
BarbieriCELeeBCooksonMSBinghamJClarkPESmithJAJrAssociation of procedure volume with radical cystectomy outcomes in a nationwide database. J Urol2007; 178: 1418–21 [discussion 1421–2].
40.
GilbertSMDunnRLMillerDCDaignaultSYeZHollenbeckBK. Mortality after urologic cancer surgery: Impact of non-index case volume. Urology2008; 71: 906–10.
41.
KleinEABiancoFJSerioAMEasthamJAKattanMWPontesJESurgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol2008.
42.
HollenbeckBKDunnRLMillerDCDaignaultSTaubDAWeiJT. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol2007; 25: 91–6.
43.
HongDTandanVRGoldsmithCHSimunovicM. Users' guide to the surgical literature: how to use an article reporting population-based volume—outcome relationships in surgery. Can J Surg2002; 45: 109–15.
