Centralization of Highly Complex Low-Volume Procedures in Upper Gastrointestinal Surgery. A Summary of Systematic Reviews and Meta-Analyses

Tol, Johanna A. M. G.; Gulik, Thomas M. van; Busch, Olivier R.; Gouma, Dirk J.

doi:10.1159/000343929

Cited by 71 publications

(45 citation statements)

References 28 publications

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“…Centralization of complex upper gastrointestinal surgery, especially liver surgery and the beneficial effect on outcome have been reported [41]. Centralization of liver surgery in the Netherlands led to more ‘high volume' and less ‘low volume' and ‘sporadic centers', as observed in the current study.…”

Section: Discussionsupporting

confidence: 69%

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Ridder

Lemmens²,

Overbeek³

et al. 2016

Dig Surg

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Objective: The study aims to evaluate all patients who underwent liver resection for metastatic disease for demographics, characteristics of the primary tumor and metastasis, volume of liver resection specimens per pathology laboratory and to describe trends in surgical treatment. Methods: Data were prospectively collected using the Dutch nationwide pathology network. All pathology reports containing details on liver resections for metastatic disease between January 2001 and December 2010 were evaluated. Results: A total of 3,916 liver resections were performed in 3,699 patients with a median age of 63 years (range 1-91). The primary tumor was mainly colorectal (n = 3,256; 88.0%). The number of ‘high volume liver centers' increased from 2 to 12 in the study period, whereas the number of ‘low volume centers' decreased. The number of liver resections increased from 224 to 596 per year (p ≤ 0.0001). A significant increase was demonstrated in elderly patients, patients with multiple metastases, liver resections for smaller metastases and minor liver resections. Conclusion: Although the majority of patients were young and had solitary metastasis, indications for liver resection are expanding as indicated by increasing numbers of elderly and patients with multiple liver metastases. Patients with non-colorectal liver metastases were seldom candidates for resection.

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Section: Discussionsupporting

confidence: 69%

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Ridder

Lemmens²,

Overbeek³

et al. 2016

Dig Surg

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“…Thereafter, the surgeon achieves a better postoperative outcome, including reduced operative time and duration of hospital stay 11,28,38 . In the current study, 38 surgeons (73.0%) performed ≥50 PDs, but only 12 surgeons (28.8%) performed >20 PDs last year, defined as high volume.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure requires a high level of experience and standards with regard to technical aspects as well as perioperative care. Minimization of surgery-related mortality and morbidity is imperative, and an important feature of highquality standard surgery 9,28,38 . Centralization of highly complex surgery has been discussed extensively during the past decade and in pancreatic resection has been associated with a decrease in hospital mortality and costs.…”

Section: Introductionmentioning

confidence: 99%

“…Centralization of highly complex surgery has been discussed extensively during the past decade and in pancreatic resection has been associated with a decrease in hospital mortality and costs. The differences in outcome can be explained by many variables, and surgeon-volume and hospital-volume are important factors in morbidity and mortality rates 11,38 . There is significant heterogeneity in the practice patterns of PD worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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-Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy.

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“…These facilities are crucial in esophageal surgery to properly treat intraoperative and postoperative complications and therefore directly affect surgical outcome [38]. Additionally, accredited centers have to guarantee the presence of interdisciplinary teams consisting of surgeons, medical oncologists, and radiotherapists specialized in the multimodal therapy of esophageal cancer, providing an optimal treatment concept and improving the patients' long-term survival.…”

Section: Evidence For a Benefit Of Centralizationmentioning

confidence: 99%

Is There a Rationale for Structural Quality Assurance in Esophageal Surgery

Glatz

Hoeppner²

2017

Visc Med

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Background: Advances regarding perioperative mortality rates and oncological outcomes after esophagectomy have been reported extensively by specialized high-volume centers in Europe and the USA over the last decade. However, recent database analyses reveal that the perioperative mortality of esophagectomy remains high in these countries, indicating a discrepancy between surgical quality in baseline hospitals and specialized centers. Methods: This article provides an overview over the existing literature on the correlation between structural quality, procedural volume, and surgical outcome in e- sophageal surgery. Results: Structural, procedural and outcome measures can be used to assess the quality of surgical treatment and perioperative management. Surgical procedures on the esophagus for both benign and malignant diseases are rare and typically associated with high perioperative morbidity and mortality. Usually, direct outcome measures do not provide enough statistical power to actually identify differences in surgical quality between hospitals, making structural quality measures the only feasible parameter to compare the quality of e- sophageal surgery among different centers. Several analyses from different countries have shown a strong correlation between hospital volume and postoperative mortality. Data from countries in which esophageal surgery has been centralized indicate beneficial effects of a centralized health care system on postoperative mortality after esophagectomy. Additionally, only high-volume centers generally provide optimal preoperative and postoperative management and comprehensive access to modern multimodal treatment. In Germany, esophageal surgery is still decentralized, but hospitals performing complex esophageal procedures have to fulfill minimum caseload requirements of 10 cases per year. In practice, these requirements are not met by the majority of hospitals and a detrimental effect on the achieved surgical outcomes can be noted. Conclusion: Therefore, we conclude that structural quality assurance is crucial to further reduce postoperative morbidity after esophageal surgery and to improve long-term results.

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Centralization of Highly Complex Low-Volume Procedures in Upper Gastrointestinal Surgery. A Summary of Systematic Reviews and Meta-Analyses

Cited by 71 publications

References 28 publications

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Pancreatoduodenectomy: Brazilian practice patterns

Is There a Rationale for Structural Quality Assurance in Esophageal Surgery

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