Volume-outcome association in bariatric surgery: a systematic review.
ABSTRACT To systematically examine the association between annual hospital and surgeon case volume and patient outcomes in bariatric surgery.
Bariatric surgery remains a technically demanding field with significant risk for morbidity and mortality. To mitigate this risk, minimum annual hospital and surgeon case volume requirements are being set and certain hospitals are being designated as "Bariatric Surgery Centers of Excellence." The effects of these interventions on patient outcomes remain unclear.
A comprehensive systematic review on volume-outcome association in bariatric surgery was conducted by searching MEDLINE, Cochrane Database of Systematic Reviews, and Evidence Based Medicine Reviews databases. Abstracts of identified articles were reviewed and pertinent full-text versions were retrieved. Manual search of bibliographies was performed and relevant studies were retrieved. Methodological quality assessment and data extraction were completed in a systematic fashion. Pooling of results was not feasible due to the heterogeneity of the studies. A qualitative summary of results is presented.
From a total of 2928 unique citations, 24 studies involving a total of 458,032 patients were selected for review. Two studies were prospective cohorts (level of evidence [LOE] 1), 3 were retrospective cohorts (LOE 3), 2 were retrospective case controls (LOE 3), and 17 were retrospective case series (LOE 4). The overall methodological quality of the reviewed studies was fair. A positive association between annual surgeon volume and patient outcomes was reported in 11 of 13 studies. A positive association between annual hospital volume and patient outcomes was reported in 14 of 17 studies.
There is strong evidence of improved patient outcomes in the hands of high-volume surgeons and high-volume centers. This study supports the concept of "Bariatric Surgery Center of Excellence" accreditation; however, future research into the quality of care characteristics of successful bariatric programs is recommended. Understanding the characteristics of high-volume surgeons, which lead to improved patient outcomes, also requires further investigation.
- SourceAvailable from: Angela GeraciOpen Medicine 01/2014;
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ABSTRACT: Background: Due to the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high and low volume centers have demonstrated mixed results. Methods: Systematic review using MEDLINE and EMBASE including all studies examining a volume-outcome relationship in the treatment of head and neck cancer patients with meta-analysis for long-term survival results. Results: Seventeen studies were identified. Meta-analysis was performed for studies that assessed long term survival. High-volume hospitals (5 studies; HR 0.886 95% CI 0.820-0.956) and high-volume surgeons (2 studies; HR 0.767 95% CI 0.641-0.919) have better overall survival than low-volume hospitals and surgeons, respectively. Conclusions: Volume-outcome associations exist for head and neck oncologic procedures although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care which may explain this relationship. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.Head & Neck 09/2013; · 2.83 Impact Factor
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ABSTRACT: Hospitals show wide variation in outcomes and systems of care. It is unclear whether hospital complexity-the range of services and technologies provided-affects outcomes and in what direction. We sought to determine whether complexity was associated with inpatient surgical mortality. Using national Medicare data, we identified all fee-for-service inpatients who underwent 1 of 5 common high-risk surgical procedures in 2008-2009 and measured complexity by the number of unique primary diagnoses admitted to each hospital over the 2-year period. We calculated 30-day postoperative mortality rates, adjusting for patient and hospital characteristics, and used multivariable Poisson regression models to test for an association between hospital complexity and mortality rates. We then used this model to generate predicted mortality rates for low-volume and high-volume hospitals across the spectrum of hospital complexity. A total of 2691 hospitals were analyzed, representing a total of 382,372 admissions. After adjusting for hospital characteristics, including hospital volume, increasing hospital complexity was associated with lower surgical mortality rates. Patients receiving care at the hospitals in the lowest quintile of unique diagnoses had a 27% higher risk of death than those at the highest quintile. The effect of complexity was largest for low-volume hospitals, which were capable of achieving mortality rates similar to high-volume hospitals when in the most complex quintile. Hospital complexity matters and is associated with lower surgical mortality rates, independent of hospital volume. The effect of complexity on outcomes for nonsurgical services warrants investigation.Medical care 03/2014; 52(3):235-42. · 3.24 Impact Factor