John P. Bunker

Should operations be regionalized? The empirical relation between surgical volume and mortality.

Abstract This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospitals surgical volume and its...

The Physician-Patient as an Informed Consumer of Surgical Services

Abstract The alleged overuse of surgical services in this country is often attributed to lack of consumer knowledge. Assuming that physicians possess such knowledge, we have examined their utilizat...

Operation Rates, Mortality Statistics and the Quality of Life

The quality of surgical care remains unmeasured. We are not yet even certain how to define the quality of care, let alone how to measure it. But we do know that there are large quantitative differe...

Should operations be regionalized? The empirical relation between surgical volume and mortality. 1979.

This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospitals surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had death rates, adjusted for case mix, 25 to 41 per cent lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. For example, hospitals doing 50 to 100 total hip replacements attained a mortality rate for this procedure almost as low as that of hospitals doing 200 or more. Some procedures, such as cholecystectomy, showed no relation between volume and mortality. The results may reflect the effect of volume or experience on mortality, or referrals to institutions with better outcomes, as well as a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations. (N Engl J Med 301:1364-1369, 1979)

Should Surgery Be Regionalized

The authors suggest that new surgical procedures be carried out initially in selected institutions and that complex procedures for which it has been or can be demonstrated that mortality is inversely related to the volume of experience also be regionalized. Regionalization in the latter instance can have a small overall impact on surgical practice but a large impact on the adverse consequences of high risk operations that are performed only occasionally.

Elective Hysterectomy: Pro and Con

We have chosen hysterectomy for these public-health rounds because of its prominence in the current national concern with accelerating costs of medical care in general, and with what is perceived a...

Effects of Thiopental Sedation on Learning and Memory

Subjects who were administered thiopental showed a loss of memory for events discussed while they were under sedation. We tested the subjects for recognition memory of pictures and recall of associated pairs of letters and words, and found that the subsequent memory loss was correlated with the concentration of thiopental in the venous blood at the time the material was learned. Retention did not appear to be state-dependent because the subject, while under sedation, could recall material learned prior to sedation, and because recall was not facilitated by reinstatement of the sedation.

Evaluation of medical-technology strategies: effects of coverage and reimbursement (first of two parts).

Rationale The current federal policy is to reduce the governments responsibility for health care and its evaluation, substituting market mechanisms whenever possible, and to vest residual control ...

Hard Times for the National Centers

IN 1973, Franz Ingelfinger called attention to the precarious budgetary support of the National Center for Health Statistics (NCHS).1 The administration had proposed a budget of

Women in Medicine

22.8 million, and ...