The volume-performance relationship in esophagectomy

Abstract

The current literature demonstrates that both hospital volume and surgeon volume are inversely related to operative mortality for esophageal resection. Given the heterogeneity of the volume-outcome literature, it is difficult to identify minimum volume thresholds at which satisfactory performance is achieved. Both volume-based hospital referral and process improvement provide compelling and sometimes competing strategies for translating evidence about volume-outcome relationships into policy. Each approach has significant limitations that preclude uniform implementation nationwide but nonetheless should be a focus for continued investigation and application, with the goal of providing uniform and high-quality care after esophagectomy.