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Richard J. Davies, MD
Hackensack, NJ

Arch Surg. 2003;138:726.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The studies by Finlayson et al and others support the notion that operative mortality is higher in low-volume hospitals. However, several questions remain: What factors are responsible for the higher mortality? Is it because of poor patient selection, more comorbidities, or inferior perioperative treatment at low-volume hospitals? Is it because patients with tumors that have a better prognosis select higher-volume hospitals? Are the surgical skills of practioners at high-volume hospitals significantly superior to those at low-volume hospitals? Are those skills transferable, or should patients with certain malignancies be transferred to high-volume units? Finally, how do we define volume? Does a low-volume surgeon at a high-volume hospital have better results than this surgeon's counterpart practicing in a low-volume hospital?

The law of diminishing returns applies to surgery as it does to politicoeconomic endeavors. Therefore, the application of effort or skill toward a particular goal (low operative mortality) . . . [Full Text of this Article]

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