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Review
. 2017 May;33(2):131-134.
doi: 10.1159/000456042. Epub 2017 Mar 30.

Influence of Hospital Volume Effects and Minimum Caseload Requirements on Quality of Care in Pancreatic Surgery in Germany

Christian Krautz  1 , Axel Denz  1 , Georg F Weber  1 , Robert Grützmann  1
Affiliations
Review

Influence of Hospital Volume Effects and Minimum Caseload Requirements on Quality of Care in Pancreatic Surgery in Germany

Christian Krautz et al. Visc Med. 2017 May.

Abstract

Introduction: Numerous international studies have identified hospital volume as significant independent variable of death following pancreatic surgery. Most of these studies were limited to regions of countries or portions of a national population and did not include data on volume-outcome effects in Germany.

Methods: The Medline database was systematically searched to identify studies that analyzed volume-outcome relationships and effects of minimum caseload requirements on outcomes of pancreatic surgery in Germany.

Results: Recent observational studies utilizing German hospital discharge data confirmed that patients undergoing pancreatic surgery in Germany also have better outcomes when treated in facilities with high annual caseloads. Besides a decreased risk of in-hospital mortality, there is also a reduced risk of 1-year mortality in high-volume hospitals. In addition, there is evidence that adherence to already existing minimum caseload requirements reduces morbidity and mortality of pancreatic surgery in Germany. As a result of an insufficient centralization in the recent past, however, a large proportion of hospitals that perform pancreatic surgery still do not meet minimum caseload requirements.

Conclusions: Specific measures (i.e. sanctions for failure to achieve minimum volumes) that initiate a sufficient centralization process without threatening patient access to surgical care are needed.

Keywords: Administrative data; Hospital volume; Minimum caseload requirements; Pancreatic surgery; Quality of care.

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Figures

Fig. 1
Fig. 1
Odds ratios for in-hospital mortality following pancreatic surgery in lower-volume compared to higher-volume hospitals.
Fig. 2
Fig. 2
Annual distribution of hospitals that performed major pancreatic resections in Germany according to hospital volume quintiles (numbers within brackets represent the mean hospital volume ± standard deviation of each hospital volume quintile) and annual overall in-hospital mortality from 2009 through 2014.
See this image and copyright information in PMC

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