Kyle Sheetz, MD, MSc Research Fellow Center for Healthcare Outcomes and Policy University of Michigan

Surgical Volume Standards Not Practical For Most Hospitals Interview with:

Kyle Sheetz, MD, MSc Research Fellow Center for Healthcare Outcomes and Policy University of Michigan

Dr. Sheetz

Kyle Sheetz, MD, MSc
Research Fellow
Center for Healthcare Outcomes and Policy
University of Michigan What is the background for this study? What are the main findings?

Response: Various patient safety organizations and clinical societies continue to advocate for volume thresholds as a means to improve the short-term safety and overall effectiveness of high risk cancer surgeries in the United States.

We asked two questions with this study:

1) What proportion of U.S. hospitals meet discretionary volume standards?

2) Do these standards differentiate hospitals based on short-term safety outcomes (mortality and complications)?

We found that a relatively low proportion of hospitals meet even modest volume standards put forth by the Leapfrog Group. These standards did not differentiate hospitals based on outcomes for 3 of 4 high risk cancer operations reported by the Leapfrog Group. However, using higher thresholds, we were able to demonstrate a significant relationship between higher hospital volume and better outcomes, which has been reported numerous times. What should readers take away from your report?

Response: The goal of this study is to highlight the tradeoffs associated with volume standards. There is an important tradeoff between patient safety and volume standards that are not practically achievable by most hospitals, thus limiting their relevance. While the volume-outcome relationship remains, care overall has gotten safer – due to many factors. What recommendations do you have for future research as a result of this work?

Response: For certain procedures, short-term safety may not be the most important outcome for patient advocacy groups or clinical societies to prioritize. There may be greater benefits from shifting the focus towards outcomes like long-term survival after high risk cancer surgery, guideline concordant care, or even patient-reported outcome measures. 

No disclosures


Sheetz KH, Chhabra KR, Smith ME, Dimick JB, Nathan H. Association of Discretionary Hospital Volume Standards for High-risk Cancer Surgery With Patient Outcomes and Access, 2005-2016. JAMA Surg. Published online August 14, 2019. doi:10.1001/jamasurg.2019.3017


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Last Updated on August 15, 2019 by Marie Benz MD FAAD