The concept of high-volume hospitals and even surgeons having improved surgical outcomes across a wide spectrum of surgical procedures has been extensively studied and reported in the surgical literature for decades. Up until now, this concept has been a topic of academic publications and presentations, and used to guide patient's decision-making through agencies such as LeapFrog. But the ultimate decision as to where patients would seek their surgical care has been left to the patients and their referring physicians. In July of 2015, in part driven by the lay press, 3 major academic institutions have announced that they would “take the volume pledge” and set a minimum volume threshold for hospitals and surgeons performing 10 different complex surgical operations within their health system. This program has reignited the volume/outcome debate amongst surgeons in the academic community, but perhaps even more strongly in general practice, as many surgeons feel that such programs might be self-serving for the academic medical centers at the expense of delivery of care for patients in rural, suburban, and even urban locations. This issue has gained the attention of the American College of Surgeons, which has formed a Committee on Volumes and Outcomes to look at all of the available data, to come to a conclusion, and make recommendations that best serve the patients across the broad spectrum of care in this country.
Annals of Surgery, in an attempt to “fuel the debate,” has asked authors on both sides of the question to offer their opinions to help frame the issue. We certainly welcome your comments this issue.