[Relation between activity volume and surgeon's results: myth or reality?]

Area of Science:

• Health Services Research
• Surgical Outcomes Research
• Medical Quality Improvement

Background:

• The relationship between surgical volume and patient outcomes is widely hypothesized.
• Demonstrating this link in real-world clinical practice requires robust evidence.
• Existing studies often lack methodological rigor for definitive conclusions.

Purpose of the Study:

• To systematically review existing literature on the relationship between surgical volume and patient outcomes.
• To identify methodological limitations in current research on this topic.
• To propose a framework for more objective assessment of volume-outcome relationships.

Main Methods:

• A qualitative systematic review was conducted.
• Searched and analyzed five systematic reviews and one hundred original research papers.
• Evaluated study methodologies, data sources, and case-mix adjustment.

Main Results:

• Most studies were retrospective, utilizing administrative data rather than medical charts.
• Limited case-mix adjustment was observed when comparing surgical units or individual surgeons.
• A positive relationship between volume and outcomes was suggested for surgical units, but less clear for individual surgeons.
• Evidence suggests the volume-outcome relationship varies significantly by surgical specialty and procedure.

Conclusions:

• Methodological flaws in current studies prevent evidence-based conclusions regarding the volume-outcome relationship.
• A more objective approach using predictive scores (comparing expected versus observed outcomes) is necessary.
• This new approach is essential for accurately assessing the impact of surgical volume on patient outcomes.