[Minimum case volumes from the perspective of specialists in smaller facilities]

The introduction of compulsory minimum hospital volumes for the majority of operations in visceral surgery according to the current state of discussions will lead to a profound change in the provision of surgical treatment in Germany.

This article gives a narrative review of the literature and evidence as well as current regulations.

In Germany gastric interventions for cancer are associated with the highest perioperative risk in visceral surgery with a mortality of 11.7%. The highest number of annual fatalities by far are reported after colorectal resections (n = 6186). The already decided and planned minimum volumes (esophagus and pancreas) not only do not address these urgent quality issues but even lead to a paradoxical decentralization effect for colorectal and gastric interventions, by weakening medium size and also large hospitals. The minimum volumes that are planned to be subsequently introduced for liver resection, gastric cancer surgery, colorectal cancer surgery, resection for diverticulitis and thyroid resection will not enable a persistence of visceral surgery as a coherent specialty in the remaining clinical landscape. As an alternative, a three-stage model is suggested that defines groups of operations with similar complexity with a common compulsory minimum volume. These groups together with the respective requirements in infrastructure, make up a certain level of care.

The model suggested will induce a meaningful differentiation of surgical treatment providers that will adequately address surgical quality as well as the preservation of visceral surgery as a coherent specialty.