[Experience in orthopaedic surgery with minimum provider volumes].

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Healthcare Policy

Background:

• Minimum provider volumes are increasingly considered for surgical procedures.
• A volume-outcome relationship is suggested in orthopaedics, particularly for joint replacements.
• Germany implemented a minimum volume for total knee replacements in 2007.

Purpose of the Study:

• To evaluate the evidence for volume-outcome relationships in orthopaedic surgery.
• To assess the potential impact of minimum volume regulations in German healthcare.
• To inform careful consideration of future volume-based healthcare policies.

Main Methods:

• Literature review on volume-outcome relationships in orthopaedic procedures.
• Analysis of existing data for total knee and hip replacements.
• Model calculations simulating the effects of volume-based regulations in Germany.

Main Results:

• A general volume-outcome relationship exists for total knee and hip replacement, but no specific threshold was identified.
• Evidence for other orthopaedic procedures is suggestive but not conclusive.
• Simulations indicate that while many hospitals might be excluded for joint replacements, patient reallocation would be minimal.

Conclusions:

• The implementation of minimum provider volumes in orthopaedic surgery requires careful planning.
• Germany's mandatory 50 total knee replacements per year policy needs cautious evaluation for broader application.
• Further careful consideration is essential due to potentially significant effects on the German healthcare system.