Influence of Hospital Volume Effects and Minimum Caseload Requirements on Quality of Care in Pancreatic Surgery in Germany

Abstract

Introduction: Numerous international studies have identified hospital volume as significant independent variable of death following pancreatic surgery. Most of these studies were limited to regions of countries or portions of a national population and did not include data on volume-outcome effects in Germany. Methods: The Medline database was systematically searched to identify studies that analyzed volume-outcome relationships and effects of minimum caseload requirements on outcomes of pancreatic surgery in Germany. Results: Recent observational studies utilizing German hospital discharge data confirmed that patients undergoing pancreatic surgery in Germany also have better outcomes when treated in facilities with high annual caseloads. Besides a decreased risk of in-hospital mortality, there is also a reduced risk of 1-year mortality in high-volume hospitals. In addition, there is evidence that adherence to already existing minimum caseload requirements reduces morbidity and mortality of pancreatic surgery in Germany. As a result of an insufficient centralization in the recent past, however, a large proportion of hospitals that perform pancreatic surgery still do not meet minimum caseload requirements. Conclusions: Specific measures (i.e. sanctions for failure to achieve minimum volumes) that initiate a sufficient centralization process without threatening patient access to surgical care are needed.

Volume and Quality in Visceral Medicine

“…They present data that strongly correlate hospital volume to surgical outcome. Similar to the paper of Krautz et al [4], the authors show that volume alone is not the only parameter with respect to mortality but that hospital infrastructure, interdisciplinary teams, and expertise in patient selection are of crucial importance. In Germany, only the minority of hospitals fulfill the minimum caseload required for esophageal surgery without any change during the last years.…”

“…Krautz et al [4] stress the importance of caseload for pancreatic surgery. They address the problem that still 50% of hospitals performing pancreatic surgery fail to meet minimum caseload requirements.…”

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

“…In the present study, hospitals treating very few patients appeared to have increased mortality rates owing to high rates of failure to rescue. Recent analyses from Germany have also highlighted that the annual caseload for complex pancreas and oesophagus resections determines the long‐term survival and failure to rescue rate in these patients. Failure to rescue depends on additional factors apart from hospital volume, such as surgical experience and the availability of interventional radiologists, an endoscopy unit and an ICU.…”

Volume-outcome relationship and minimum volume regulations in the German hospital sector – evidence from nationwide administrative hospital data for the years 2005–2007

“…In comparison to other countries the German minimum volume standards appear relatively moderate. For example the threshold in the Netherlands for interventions at the oesophagus and pancreas is 20 [38, 39]. In France there is even a threshold of 30 for pancreatic resections [39].…”