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More work is needed to define medium volume institutions and also the surgeon's volume that makes it protective for institutional outcomes.
The finding that medium volume institutions have higher odds of mortality is surprising.
20 Adjustment for structural and process of care variables seemed to have the most impact at the level of medium volume institutions.
Medium volume institutions treated proportionally fewer patients in the most deprived Carstairs fifth (highest fifth) and a greater proportion of patients older than 75 (P<0.01, table 3).
19 From the summary of adjusted probabilities (fig 3), medium volume institutions do seem to have worse in-hospital and total mortality than high volume institutions, which is consistent with previous studies.
For medium volume institutions in model 3 the odds of in-hospital mortality was 1.16, but increased to 1.72 (95% confidence interval 1.00 to 2.98, P=0.05) in model 4 (including adjustment for the structural and process of care variables).
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Results Compared with low volume institutions, medium volume ones had a significantly higher odds of in-hospital and total mortality: odds ratio 1.72 (95% confidence interval 1.00 to 2.98, P=0.05) and 1.82 (1.08 to 3.06, P=0.02).
Patients undergoing radical cystectomy for bladder cancer in medium volume (≥10 and <16 procedures per year) institutions had 72% and 82% greater odds of 30 day in-hospital and total mortality than patients undergoing the same procedure in low volume (>2 and <10 procedures per year) institutions.
Although he could push his smooth baritone voice up to medium volume, his crooning never aspired toward the operatic.
The company says it can last for 50 hours at medium volume and recharge USB devices.
What is not clear is why low volume institutions seem to have comparable outcomes to high volume institutions.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com