Hospitals that carry out higher volumes of certain rare surgical procedures report better survival rates for their patients.

Analyses of the outcomes of more than 180,000 cases of nine elective procedures carried out between 1998-1999 and 2003-2004 uncovered a link between higher hospital volumes and the risk of 30-day in-hospital mortality for three of the nine procedures: angioplasty and two cancer-related surgeries (esophagectomy and pancreatic cancer surgery, known as the Whipple procedure).

Statistically Significant Reductions

The average death rates for the three procedures ranged from 0.2% for angioplasty to 4.3% for esophagectomy.

The report shows that for every 10 additional procedures performed in a hospital, the risk of the patient dying was on average 44% lower for esophagectomies and 46% lower for Whipple procedures, after taking patient characteristics and the year that the procedure was performed into account.

However, both procedures are relatively rare. Many hospitals perform fewer than 5 each year; a handful perform more than 30.

A smaller but still statistically significant effect was seen for angioplasties, with a 1% reduction in 30-day in hospital mortality for every 10 additional procedures.

For the remaining six procedures, there was no significant association between hospital volumes and 30-day in-hospital mortality -- or a difference was seen only between hospitals performing the highest and lowest volumes of surgery.

Hospitals That Do More Do Better

"This study makes it clear that for some surgeries, a patient's chance of short-term survival is better when surgery is done at a hospital performing higher volumes of that procedure," says CIHI President and CEO Glenda Yeates.

"When you combine this new Canadian analysis with the international research on this topic, the link with quality of care is clear -- and this is the primary reason why these findings are so important to Canadians," she added.

Health Care in Canada 2005 is CIHI's sixth annual publication on the state of the health care system. This year's report focuses on the relationship between the volume of surgeries performed in a hospital and patient outcomes, including a new in-depth review of existing studies, new analyses of Canadian data and a new survey of Canadians' views.