Volume‐ or outcome‐based referral to improve quality of care for esophageal cancer surgery in The Netherlands

Abstract

Recently, in The Netherlands esophageal resections for cancer are banned from hospitals with an annual volume less than 10. In this study we evaluate the validity of this specific volume cut-off, based on a review of the literature and an analysis of the available data on esophagectomies in our country. In addition, we compare the expected benefits of volume-based referral to the results of a regional centralization process based on differences in outcome (outcome-based referral).

Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

“…This volume-to-outcome relationship was demonstrated in the Netherlands when centralization of esophageal resection was implemented [31,32]. Therefore, as we transitioned from an open to a minimally invasive esophagectomy center during the past 3 years, we were careful to ensure that our surgical results, preoperative patient selection, and neoadjuvant chemoradiation therapy did not change and affect our surgical outcomes.…”

A Tale of Two Provinces: Regionalization of Pancreatic Surgery in Ontario and Quebec

“…In the Netherlands, minimal volume standards for esophagectomy have markedly reduced the number of hospitals performing that procedure, increased average volumes in remaining centers, and dramatically reduced operative mortality over the past 10 years. 5,6 In contrast, there have been no coincident trends in either market concentration or mortality with pancreatectomy, for which the Netherlands has not set volume standards. 7 Why did market concentration in Quebec fail to result in comparable improvements in operative mortality with pancreatic resection?…”

Is There a Rationale for Structural Quality Assurance in Esophageal Surgery

“…A population-based study from the Netherlands showed that hospital volume accounted for only 50% of the variation in mortality between the hospitals. Differences in infrastructure, patient selection, surgical expertise, and availability of multidisciplinary teams seem to be equally important [36].…”

“…Several studies analyzing the correlation between postoperative mortality and hospital volume show a significant decrease in mortality in centers with 20 or more procedures a year [16,36]. A recent study from France even demonstrates a further reduction in postoperative mortality in centers with more than 40 or more than 60 procedures per year even for low-risk patients [31], and results from a large European multicenter trial demonstrate a significant reduction of postoperative mortality for a procedural volume of more than 80 operations per year [28].…”