Provider volume and outcomes for oncological procedures.

Abstract

BACKGROUND:

Oncological procedures may have better outcomes if performed by high-volume providers.

METHODS:

A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible.

RESULTS:

Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite.

CONCLUSION:

High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

• Authors: S D Killeen, M J O'Sullivan, J C Coffey, W O Kirwan, H P Redmond
• Journal: The British journal of surgery (Br J Surg) Vol. 92 Issue 4 Pg. 389-402 (Apr 2005) ISSN: 0007-1323 [Print] England
• PMID: 15786424 (Publication Type: Journal Article, Review)

Topics

• Health Facility Size
• Hospitals (statistics & numerical data)
• Humans
• Neoplasms (mortality, surgery)
• Surgical Procedures, Operative (statistics & numerical data)
• Treatment Outcome
• Workload (statistics & numerical data)