Relationship between surgeon volume and outcomes: A systematic review of systematic reviews

被引：259

作者：

Morche J. ^{[1
]}

Mathes T. ^{[2
]}

Pieper D. ^{[2
]}

机构：

[1] The University Hospital of Cologne (AöR), Institute of Health Economics and Clinical Epidemiology, Gleueler Str. 176-178, Cologne

[2] Witten/Herdecke University, Faculty of Health, School of Medicine, Institute for Research in Operative Medicine, Ostmerheimer Str. 200, Building 38, Cologne

来源：

Systematic Reviews | / 5卷 / 1期

关键词：

Clinical outcome; Patient safety; Quality assurance; Surgeon volume; Systematic review of systematic reviews; Volume-outcome;

D O I：

10.1186/s13643-016-0376-4

中图分类号：

学科分类号：

摘要：

Background: The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence. Methods: Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition. Results: Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects. Conclusions: When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue. © 2016 The Author(s).

引用

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