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resections. Differences in socio-demographics and risk-factors between the
hospital volume categories were adjusted for in multivariable analyses. The
authors found diminished mortality with increasing hospital volume for all 14
surgical procedures. Based on these findings, Birkmeyer et al. concluded
that patients undergoing cardiovascular or cancer procedures can significantly
decrease the mortality by selecting a high-volume hospital.
Access to Health Care
Equality in health care utilization has become an increasingly important
issue for surgical outcomes research over the past decade. Racial18-21 and
socio-economic19 differences have been identified as independent factors
for inequality of access to health care. In cancer patients, several investigations
reported that African-American patients receive less intensive treatment
or have poorer outcomes for breast, 22 prostate, 23 colon and rectum, 24,
25 19, 26 and lung cancer. It is clear that well-designed studies that reveal potential
socio-economic or racial discrepancies in access to health care are of
greatest importance to the medical community, policy makers, and the general
public.
For obvious reasons, however, access to health care can not be assessed
in a randomized clinical trial. We then see that surgical outcomes research
wonderfully complements the randomized clinical trial in this regard, as outlined
in the example below:
Cooper and colleagues identified predictors associated with patients undergoing
potentially curable surgical therapy for resectable colorectal cancer,
basing their research on a large database that included 81`579 Medicare
beneficiaries. 25 The authors found that African-Americans were significantly
less likely to undergo potentially curative surgery compared with white
patients (78% versus 68%, p