FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2786014923> ?p ?o ?g. }

• W2786014923 endingPage "2696" @default.
• W2786014923 startingPage "2695" @default.
• W2786014923 abstract "Central MessageThis article joins several contemporary reports in challenging the notion of volume-outcome relationships and will force us to look into additional parameters to define outcome-related factors.See Article page 2683. This article joins several contemporary reports in challenging the notion of volume-outcome relationships and will force us to look into additional parameters to define outcome-related factors. See Article page 2683. Thoracic surgeons continue to cope with the ever-constant challenge of mitigating risk and decreasing complications. Luft and colleagues1Luft H.S. Bunker J.P. Enthoven A.C. Should operations be regionalized? The empirical relation between surgical volume and mortality.N Engl J Med. 1979; 301: 1364-1369Crossref PubMed Scopus (1412) Google Scholar first reported a 41% lower case-adjusted postoperative death rate in high-volume institutions. Forty years later, the volume-outcome relationship has gained significant momentum. Several publications have supported the notion of a need for minimal volume standards and have been the impetus behind centralization of care.2Birkmeyer J.D. Dimick J.B. Birkmeyer N.J. Measuring the quality of surgical care: structure, process, or outcomes?.J Am Coll Surg. 2004; 198: 626-632Abstract Full Text Full Text PDF PubMed Scopus (381) Google Scholar, 3Birkmeyer J.D. Siewers A.E. Finlayson E.V. Stukel T.A. Lucas F.L. Batista I. et al.Hospital volume and surgical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137Crossref PubMed Scopus (4096) Google Scholar, 4Livingston E.H. Cao J. Procedure volume as a predictor of surgical outcomes.JAMA. 2010; 304: 95-97Crossref PubMed Scopus (91) Google Scholar The concept is intuitive: centers that perform more surgeries should accordingly have the benefit of lower complications. More recent evaluation, however, has questioned this otherwise obvious premise. In this issue of the Journal, in a study that used an administered database and predetermined hospital volume cutoffs, Harrison and colleagues5Harrison S. Tangel V. Wu X. Christos P. Gaber-Baylis L. Turnbull Z. et al.Are minimum volume standards appropriate for lung and esophageal surgery?.J Thorac Cardiovasc Surg. 2018; 155: 2683-2694.e1Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar compared short-term outcome differences after lobectomies and pneumonectomies and after esophagectomies. A propensity score–matched analysis demonstrated no major differences between low- and high-volume centers with regard to in-hospital mortality and major complications. Essentially, Harrison and colleagues5Harrison S. Tangel V. Wu X. Christos P. Gaber-Baylis L. Turnbull Z. et al.Are minimum volume standards appropriate for lung and esophageal surgery?.J Thorac Cardiovasc Surg. 2018; 155: 2683-2694.e1Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar argue that surgical volume in isolation does not capture the magnitude of differences among centers, and it is perhaps these inherent differences between institutions (such as patient comorbidities, socioeconomic status, and age) that actually account for observed surgical outcome differences. This work by Harrison and colleagues5Harrison S. Tangel V. Wu X. Christos P. Gaber-Baylis L. Turnbull Z. et al.Are minimum volume standards appropriate for lung and esophageal surgery?.J Thorac Cardiovasc Surg. 2018; 155: 2683-2694.e1Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar certainly challenges the status quo, and it is in line with more recent literature that questions the almost dogmatic approach that links lower complication and mortality with higher volumes. In their recent review, Kozower and Stukenborg6Kozower B.D. Stukenborg G.J. Volume-outcome relationships in thoracic surgery.Thorac Surg Clin. 2017; 27: 251-256Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar highlight key issues challenging volume-outcome research and its associated conclusions. First, volume cutoffs are arbitrarily assigned and analyzed categorically, as opposed to as continuous variables (which would be better for evaluating whether a linear relationship exists). Second, most studies do not account for clustering effects within hospitals (the assumption that individuals within a single institution may be correlated) and therefore underestimate variance while inflating effect size. Finally, most research in this field relies on administrative data sets that generally lack granular patient-specific details and provide large sample size with increased potential for statistical significance but not clinically meaningful differences. Fittingly, a recent report from Ontario, Canada, where regionalization of thoracic surgery was implemented in 2007, demonstrated that centralization to high-volume centers was not associated with improved operative mortality.7Bendzsak A.M. Baxter N.N. Darling G.E. Austin P.C. Urbach D.R. Regionalization and outcomes of lung cancer surgery in Ontario, Canada.J Clin Oncol. 2017; 35: 2772-2780Crossref PubMed Scopus (48) Google Scholar By using a propensity-matched analysis, the current study by Harrison and colleagues5Harrison S. Tangel V. Wu X. Christos P. Gaber-Baylis L. Turnbull Z. et al.Are minimum volume standards appropriate for lung and esophageal surgery?.J Thorac Cardiovasc Surg. 2018; 155: 2683-2694.e1Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar attempts to control for baseline differences between high- and low-volume centers, other than of surgical volumes themselves, that can account for differences in outcomes. The results support the notion that outcomes after lung and esophageal surgery appear to be related to factors other than surgical volumes alone. Harrison and colleagues5Harrison S. Tangel V. Wu X. Christos P. Gaber-Baylis L. Turnbull Z. et al.Are minimum volume standards appropriate for lung and esophageal surgery?.J Thorac Cardiovasc Surg. 2018; 155: 2683-2694.e1Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar acknowledge the inherent limitations of database research, and they have used multilevel mixed-effects regression models to account for clustering at the hospital level. Admittedly, the analysis does not evaluate volume as a continuous variable, and it does not consider the interplay of surgeon volume versus hospital volume, as it is possible for a low-volume hospital to host data from a high-volume surgeon, potentially confounding comparisons from hospital to hospital. Is evaluating quality metrics after oncologic thoracic surgery perhaps more than a numbers game? Does practice make perfect in the world of thoracic surgery? The answer is not a clear yes, but neither is it a clear no. There are several factors other than volume that have tremendous impact on surgical outcomes and are often neglected in the policy-making sector. Beyond volume, our societies should evaluate the effects on patient outcomes of surgeon training, quality of surgery, access to multidisciplinary teams, and surgeon decision-making support. The most likely truth is that practice is but one part of being perfect. Minimum volume standards oversimplify the multidimensional nature of surgical outcomes research and should probably not be used as proxies of quality in isolation of other important parameters. Numbers don't lie, but they can be complex. Are minimum volume standards appropriate for lung and esophageal surgery?The Journal of Thoracic and Cardiovascular SurgeryVol. 155Issue 6PreviewSeveral medical systems have adopted minimum volume standards for surgical procedures, including lung and esophageal resection. We sought to determine whether these proposed hospital cutoffs are associated with differences in outcomes. Full-Text PDF Open Archive" @default.
• W2786014923 created "2018-02-23" @default.
• W2786014923 creator A5018176190 @default.
• W2786014923 creator A5055457781 @default.
• W2786014923 date "2018-06-01" @default.
• W2786014923 modified "2023-10-17" @default.
• W2786014923 title "Volume-outcome relationships: Does practice really make perfect?" @default.
• W2786014923 cites W1790986774 @default.
• W2786014923 cites W1987915512 @default.
• W2786014923 cites W1995801962 @default.
• W2786014923 cites W2046133119 @default.
• W2786014923 cites W2610994473 @default.
• W2786014923 cites W2730312532 @default.
• W2786014923 cites W2773676026 @default.
• W2786014923 doi "https://doi.org/10.1016/j.jtcvs.2018.01.074" @default.
• W2786014923 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/29501231" @default.
• W2786014923 hasPublicationYear "2018" @default.
• W2786014923 type Work @default.
• W2786014923 sameAs 2786014923 @default.
• W2786014923 citedByCount "2" @default.
• W2786014923 countsByYear W27860149232019 @default.
• W2786014923 countsByYear W27860149232023 @default.
• W2786014923 crossrefType "journal-article" @default.
• W2786014923 hasAuthorship W2786014923A5018176190 @default.
• W2786014923 hasAuthorship W2786014923A5055457781 @default.
• W2786014923 hasBestOaLocation W27860149231 @default.
• W2786014923 hasConcept C121332964 @default.
• W2786014923 hasConcept C144237770 @default.
• W2786014923 hasConcept C148220186 @default.
• W2786014923 hasConcept C20556612 @default.
• W2786014923 hasConcept C33923547 @default.
• W2786014923 hasConcept C71924100 @default.
• W2786014923 hasConcept C97355855 @default.
• W2786014923 hasConceptScore W2786014923C121332964 @default.
• W2786014923 hasConceptScore W2786014923C144237770 @default.
• W2786014923 hasConceptScore W2786014923C148220186 @default.
• W2786014923 hasConceptScore W2786014923C20556612 @default.
• W2786014923 hasConceptScore W2786014923C33923547 @default.
• W2786014923 hasConceptScore W2786014923C71924100 @default.
• W2786014923 hasConceptScore W2786014923C97355855 @default.
• W2786014923 hasIssue "6" @default.
• W2786014923 hasLocation W27860149231 @default.
• W2786014923 hasLocation W27860149232 @default.
• W2786014923 hasOpenAccess W2786014923 @default.
• W2786014923 hasPrimaryLocation W27860149231 @default.
• W2786014923 hasRelatedWork W1986041813 @default.
• W2786014923 hasRelatedWork W2225622618 @default.
• W2786014923 hasRelatedWork W2316944248 @default.
• W2786014923 hasRelatedWork W2344096376 @default.
• W2786014923 hasRelatedWork W2518900733 @default.
• W2786014923 hasRelatedWork W2748952813 @default.
• W2786014923 hasRelatedWork W2889237311 @default.
• W2786014923 hasRelatedWork W2899084033 @default.
• W2786014923 hasRelatedWork W3031052312 @default.
• W2786014923 hasRelatedWork W3032375762 @default.
• W2786014923 hasVolume "155" @default.
• W2786014923 isParatext "false" @default.
• W2786014923 isRetracted "false" @default.
• W2786014923 magId "2786014923" @default.
• W2786014923 workType "article" @default.