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. 2025 Jun 28;25(1):824.
doi: 10.1186/s12913-025-12982-5.

Anticipated effects of centralising complex gastrointestinal surgery in a rural area in Germany - perspective of health professionals: a qualitative study

Charlotte M Kugler  1   2 , Stephan Gretschel  3   4 , Julia Scharfe  5   6 , Stefanie Pfisterer-Heise  5   6 , René Mantke  7   8 , Dawid Pieper  5   6
Affiliations

Anticipated effects of centralising complex gastrointestinal surgery in a rural area in Germany - perspective of health professionals: a qualitative study

Charlotte M Kugler et al. BMC Health Serv Res. .

Abstract

Background: For centralising complex gastrointestinal surgery, minimum volume standards have been implemented in Germany. To increase centralisation and thus patient safety, the minimum volume standards for complex oesophageal and pancreatic surgery were set to rise in 2023 and 2025, respectively. Hospitals that do not meet these minimum volume standards will lose authorisation to perform these surgical procedures and are not eligible for reimbursement. Volume-outcome studies focus on patient outcomes at high or low hospital volumes. Other impacts on the service, professionals (e.g. medical training) are not covered. Therefore, the study aims to add health care professionals’ perspectives on centralisation in Brandenburg, a sparsely populated federal state in the East of Germany. It investigates what effects they anticipate and aims to identify potential solutions.

Methods: We conducted 19 semi-structured expert interviews with regional health care professionals (diverse professions and specialisations, hospital and outpatient) and patient representatives between 07/2022 and 01/2023. Interviews were transcribed and analysed according to qualitative content analysis.

Results: Healthcare professionals and patient representatives anticipated a trend towards consolidating complex oesophageal and pancreatic surgery into a few number of specialised clinics for surgical procedures (specialised centres). Conversely, there could be a rise in the number of clinics no longer offering these procedures, but instead focusing on serving as regional centres to provide general care, diagnostics, and post-discharge follow-ups for oesophageal and pancreatic patients. This redistribution might also have unintended effects on treatments beyond the scope of the minimum volume standards and could influence medical training programs and the recruitment of medical staff. Fostering structural collaboration among hospitals was suggested as a solution.

Conclusions: The results indicate that centralisation could not only influence outcome quality and accessibility, but could also lead to a range of other consequences. Especially in sparsely populated areas, meeting new minimum volume standards proves to be demanding in terms of both patients accessing complex gastrointestinal surgery and facilitating effective communication between specialised centres and regional centres or local healthcare providers.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-12982-5.

Keywords: Centralization; Rural care; Visceral surgery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All methods were carried out in accordance with relevant guidelines (Helsinki Declaration) and national law. The need for ethics approval was waived by the ethics committee of Medical School Brandenburg (Theodor Fontane), Waiver number: E-03-20220623. All participants gave their written informed consent to participate in the study. Consent for publication: Not applicable. Competing interests: SG and RM head the surgical departments of two hospitals in the federal state of Brandenburg. Their departments are directly affected by the increased minimum volume standards. All other authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Fig. 1
Fig. 1
Map of Brandenburg
Fig. 2
Fig. 2
Anticipated effects of minimum volume standards Legend: The size corresponds the frequency with which the topics were mentioned in different interviews. Created with Wordclouds.com [zygomatic]
See this image and copyright information in PMC

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