Getting the best results from surgery

Sir, – I applaud Dr Deirdre Nally and Mr Ken Mealy's study showing an association between low-volume surgical teams and higher in-hospital mortality (Paul Cullen, Home News, November 18th). A frank, evidence based discussion is long overdue around the configuration of acute surgical services in Ireland.

However, I would urge caution in the interpretation of the study’s findings.

High-volume teams achieved comparable outcomes regardless of setting.

Thus, proposed centralisation of acute services to our cities needs to be reciprocated with “out-centralising” of other services, particularly non-acute and ambulatory.


Not every “national centre” needs to be in Dublin, Cork or Galway – just ask the many patients and families who regularly get stuck in city traffic en route to routine appointments. Plainly, this means increasing, not decreasing, funding to peripheral hospitals and properly incentivising staff to work therein. – Yours, etc,


London School of Hygiene &

Tropical Medicine,

London, UK.