Costs, quality, and the volume of surgical oncology procedures

E. Munoz, K. Mulloy, J. Goldstein, N. Tenenbaum and L. Wise
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042.

We tested the hypothesis that hospital costs and outcome (ie, mortality) would differ for each surgeon by the volume of patients treated per diagnosis related group by individual surgical oncologists. All elective surgical oncologic admissions (N = 2627) to our hospital from 1985 to 1987 were divided into those patients treated by low-volume surgeons vs those patients treated by high-volume surgeons; 11.9% of patients not fitting these categories were excluded. Patients of the 57 low-volume surgeons utilized greater hospital resources (which resulted in losses instead of profits) and had a higher mortality compared with patients of the 17 high-volume surgeons. This was due, in part, to a greater severity of illness. These findings suggest that hospital costs and perhaps outcome may be related, at the individual surgeon level, to the volume of surgical procedures performed, and that the diagnosis related group prospective payment system may provide disincentives for low-volume surgeons.