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Relationship between Patient Safety and Hospital Surgical Volume


Address correspondence to Tina Hernandez-Boussard, Ph.D., M.P.H., Department of Surgery, Stanford University School of Medicine, 1070 Arastradero, #307 Palo Alto, CA 94306; e-mail:



To examine the relationship between hospital volume and in-hospital adverse events.

Data Sources

Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.

Study Design

In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.

Principal Findings

Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).


These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.