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Provider volume and outcomes for oncological procedures
S D Killeen1, M J O'Sullivan, J C Coffey
1Department of Surgery, Cork University Hospital and University College Cork, Cork, Ireland.
The British Journal of Surgery
|March 24, 2005
Summary
High-volume providers significantly improve outcomes for complex cancer surgeries. This review confirms that increased surgical volume correlates with better patient results, especially in procedures like pancreatectomy and gastrectomy.
Area of Science:
- Oncology
- Health Services Research
- Surgical Outcomes
Background:
- Provider experience and surgical volume are hypothesized to influence patient outcomes in oncological procedures.
- Establishing a definitive link between provider volume and treatment success is crucial for optimizing cancer care delivery.
Purpose of the Study:
- To systematically review and synthesize evidence on the relationship between provider volume and patient outcomes in oncological surgery.
- To identify specific cancer procedures where a volume-outcome relationship is most pronounced.
Main Methods:
- Comprehensive literature search of Medline, Embase, and Cochrane databases for English-language studies.
- Inclusion criteria: patient cohorts from 1984 onwards, community/population-based studies, assessing health outcome (dependent) and volume (independent).
- Quantitative scoring for generalizability and analysis by organ system; estimation of numbers needed to treat where feasible.
Main Results:
- Sixty-eight studies were identified, with 41 included (13 clinical data-based).
- All studies indicated an inverse relationship between provider volume and mortality, or no volume-outcome effect.
- Clinical reports predominantly showed a statistically significant positive correlation between surgical volume and improved patient outcomes.
Conclusions:
- High-volume providers demonstrate significantly better outcomes for complex cancer surgeries.
- Specific procedures with notable volume-outcome benefits include pancreatectomy, oesophagectomy, gastrectomy, and rectal resection.
- Evidence supports centralizing complex oncological surgeries with high-volume providers to enhance patient survival and recovery.