Key result
High hospital and/or surgeon volume was associated with lower mortality after upper gastrointestinal surgery in over 90% of the reviewed systematic reviews.
Why the study?
Does surgery at high-volume centers and by high-volume surgeons reduce postoperative mortality in patients undergoing complex upper gastrointestinal surgery?
Systematic Review
Does surgery at high-volume centers and by high-volume surgeons reduce postoperative mortality in patients undergoing complex upper gastrointestinal surgery?
Centralization of complex upper gastrointestinal surgery to high-volume centers is associated with lower postoperative mortality, though hospital infrastructure and care processes are also critical factors.
Answers are grounded in this paper and cite their sources.
May support centralization for upper GI surgery; leaves open infrastructure contributions in Level 5 observational syntheses.
Centralization of complex upper gastrointestinal (GI) surgery and the effect on postoperative outcomes, especially mortality, has been reported extensively in the literature. In this review the highest level of evidence on the volume outcome relationship is discussed together with other important aspects that can influence postoperative outcomes. Do high-volume centers and surgeons result in better outcomes after surgery for the different upper GI surgical procedures such as esophageal, gastric, liver and pancreatic tumors? Twelve systematic reviews including four meta-analyses described the effect of hospital and/or surgeon volume on mortality. The majority of reviews (>90%) showed a lower mortality in high-volume hospitals. This correlation was also reported when analyzing the different GI procedures separately for esophageal, gastric, hepatic and pancreatic tumors. The volume discussion has limitations and therefore the relationship between hospital structure and process of care in hospitals and the outcome of surgery has also been acknowledged. Besides surgeon expertise and skills, high-intensity intensive care units, 24/7 availability of interventional radiology, effective prevention and managing of complications and adequate patient selection will influence postoperative outcomes. These forms of hospital structures and process of care might even play a more important role in surgical outcomes.
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Tol et al. (2012) conducted a systematic review in Upper gastrointestinal tumors requiring surgery. High hospital and/or surgeon volume vs. Low volume was evaluated on Mortality. High hospital and/or surgeon volume was associated with lower mortality after upper gastrointestinal surgery in over 90% of the reviewed systematic reviews.
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