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The Leapfrog Group standards for evidence-based hospital referral underwent significant revision in 2003. In addition to other changes, risk-adjusted mortality and process of care measures now augment or replace volume standards for some procedures. The objective of this study was to estimate the potential benefits of these newly expanded standards.

Leapfrog's 2003 standards were based on minimum volume standards alone for 2 operations (esophagectomy, pancreatectomy), volume standards and a process measure (perioperative beta blockade) for 1 operation (abdominal aortic aneurysm repair), and volume standards coupled with risk-adjusted mortality rates for 2 operations (coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]). We used data from the 2000 Nationwide Inpatient Sample to determine eligible surgical populations, volume–outcome …