Volume–outcome relationship in pancreatic surgery

The quality of surgery is directly dependent on the quantity, more specifically, on the number of operations performed at a given hospital as well as on the designated surgeon. This fact is supported by numerous studies and meta-analyses that will be presented in the following text. Most of the convincing data for complex procedures can be obtained from visceral (upper and lower gastrointestinal) surgery studies. Mortality of large oncological procedures, such as esophageal or pancreatic surgery, can be reduced by 50% if a certain number of interventions are guaranteed per year. Centralizing these operations performed by specialized surgeons is the key to success. This also ensures that the minimum volume amounts within a given hospital are well above the required levels, thus enabling to teach the necessary expertise step by step. The obligatory ‘learning curve' for complex interventions cannot be completed within the framework of reference figures during residency training. Together, surgeons and their respective societies have introduced a proposal for efficient case-oriented centralized surgery. Whether ‘we are there yet' in surgery will depend in the end on how these efforts will be incorporated into administrative requirements and the guidelines that will then be implemented across the board.

Section: Surgical Oncologymentioning

confidence: 84%

Minimum Volume Standards in Surgery - Are We There Yet

Bauer¹,

Honselmann

2017

“…After screening of titles and abstracts, 51 articles were excluded and of the remaining 6, 4 publications were suitable for inclusion in the present study [9,[11][12][13].…”

Section: Resultsmentioning

confidence: 99%

“…This study found a mild trend towards a concentration of care structures within the field of pancreatic surgery from 2005 through 2011 (percentage of hospitals with caseload below minimum caseload requirements: 64.1 to 48.7%; percentage of pancreatic surgery cases in hospitals below minimum caseload requirements: 19.4 to 11.4%, respectively), which seemed to stop between 2011 and 2013 [9]. Another study assessed volume-outcome relationships related to pancreatic surgery using hospital discharge data from Germany's largest provider of statutory health insurance [13]. Although this provider covers only 30% of Germany's population, its database offers the possibility to follow up patients for up to 1 year beyond the initial inpatient episode.…”

Section: Resultsmentioning

confidence: 99%

“…Although this provider covers only 30% of Germany's population, its database offers the possibility to follow up patients for up to 1 year beyond the initial inpatient episode. Based on this feature, Alsfasser et al [13] were able to demonstrate that hospitals of the lowest volume quintile exhibited not only the highest in-hospital mortality (adjusted odds ratios (AOR): 2.1 (95% confidence interval (CI): 1.4-3.0)) but also the highest 90-day mortality (AOR: 1.9 (95% CI: 1.4-2.6)) and 1-year mortality (AOR: 1.7 (95% CI 1.4-2.2)) compared to hospitals of the highest volume quintile. Finally, Nimptsch et al [9] used nationwide German hospital discharge data to investigate the association between adherence to minimum caseload requirements and outcome of complex in-hospital procedures such as pancreatic surgery.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Krautz¹,

Denz²,

Weber³

et al. 2017

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.

“…According to current routine data, however, the overall mortality in Germany is approximately 10% [8,14]. The recently conducted multicenter randomized trial RECOPANC on pancreatoduodenectomy also showed a mortality of just over 5%, although participants were academic high-volume centers for pancreatic surgery [15].…”

Section: Reference Values For Perioperative Mortalitymentioning

confidence: 99%

Quality Indicators in Pancreatic Surgery: Lessons Learned from the German DGAV StuDoQ|Pancreas Registry

Wellner

Keck

2017

Background: Political and public interest in quality management in surgery is increasing. The German Society for General and Visceral Surgery (DGAV) established the DGAV StuDoQ, a nationwide registry for quality assessment in visceral surgery, with the organ-specific module DGAV StuDoQ|Pancreas. The first prerequisite for the measurement of quality is the definition of quality indicators. These can be related to risk factors which are also documented in the registry. Methods: Quality indicators for pancreatic surgery were developed by review of the current literature and expert consensus. After ranking the potential quality indicators, three essential indicators for outcome quality were selected for further review of the literature. Current figures were extracted from the DGAV StuDoQ|Pancreas registry and the correlation with selected risk factors was tested. Results: Three essential outcome quality indicators were selected: in-hospital mortality, TV30, and severe complications according to the Clavien-Dindo Classification. Preliminary data confirms the validity of risk factors included in the DGAV StuDoQ|Pancreas registry. Conclusion: Essential quality indicators were defined for pancreatic surgery. The DGAV StuDoQ|Pancreas constitutes a valid platform for risk-adjusted quality assessment in Germany.