The association between surgical volume, survival and quality of care.

Improving surgical outcomes is important to the thoracic surgical community and operative mortality is often used as a benchmark to gauge the quality of lung resection. In lung cancer surgery, increasing hospital volume is associated with better survival although the categorisation of procedure volume is arbitrary. When US and UK data are scrutinised, the association holds true for increasingly higher volumes up to 150 resection per year and more. The reason may be due to better infrastructure, better-staffed units, more resources and wider specialist and technology-based services in higher volume centers. For individual surgeon volume, reports are not consistent. However, studies suggest that surgeon sub-specialty is an important consideration. The results of general thoracic surgeons and cardiac surgeons are reported to be better than general surgeons for lung resection surgery, and the effects of specialty training was also associated with an increase in the number of patients undergoing lung resection. We conclude that the current evidence strongly supports the association between increasing hospital volume with lower mortality and improved long-term survival following lung resection. Whilst the data presented supports centralization of lung cancer surgery in high volume hospitals, patient choice and the threshold of quality of improvement required to overcome travel and closure of local services need to be considered.