Thoracic Surgery Volume-Quality Relationship.

This article evaluates the volume-outcome relationship in thoracic surgery. While higher hospital and surgeon volumes have been associated with improved patient outcomes, it remains unclear whether higher volumes lead to better outcomes. Factors such as case mix, surgical judgment and expertise, institutional resources, and referral patterns may explain some, or all, of the observed associations. Mandatory surgeon and hospital volume thresholds overlook the multitude of factors that drive quality, and may have unintended consequences for patients, providers, and the health care system. Comprehensive frameworks integrating structural, process, and outcome measures may provide an improved approach to evaluating surgical quality.