Authors' objectives: At the request of the Comite de l'evolution des pratiques en oncologie (CEPO), the oncology assessment unit of the Agence d'évaluation des technologies et des modes d'intervention en sante (AETMIS) was given the task of examining the effect of operative volume on clinical outcomes. This report therefore examines the published scientific literature on this topic in order to assess the relationship between hospital and surgeon volume or surgeon specialty (thoracic or general surgery) on the one hand, and postoperative mortality on the other, and to attempt to define a surgical volume threshold associated with better quality of care.

Authors' recommendations: From this analysis, based on the recommendations in other jurisdictions and on studies whose methodological weaknesses and heterogeneity call for caution when interpreting their results, AETMIS arrives at the following conclusions:With regard to surgical volume:There is an inverse association between hospital or surgeon volume and postoperative mortality.With regard to the surgeon's specialty:The association between the surgeon's specialty and surgical outcomes is not sufficiently explored by the studies.With regard to standard thresholds:The literature proposes several categories of high and low hospital or surgeon volume but do not define the threshold for designating centres of excellence for complex surgeries, such as esophagectomies. However, the organizations that have addressed this matter in Canada, the United States and Europe have set minimum thresholds ranging from 6 to 25 esophagectomies per year.With regard to the organization of services:The beneficial effect attributed to hospital or surgeon volume might be closely associated with the hospital's characteristics, such as patient management by a multidisciplinary team or the expertise of the health professionals (oncologists, anesthesiologists, intraoperative and postoperative care team, intensive care, etc.). These organizational aspects could be associated with a high annual volume of esophagectomies.Esophagectomy is a complex surgical procedure that should be reserved for high-surgical-volume facilities and performed by surgeons with extensive experience in this type of surgery or even a subspecialty in thoracic surgery.In Québec, the hospital databases should be used to perform a more detailed comparison of the postoperative mortality rates observed in hospitals with different esophagectomy volumes and obtain a picture of their quality of care.

Project Status: Completed

Year Published: 2011

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/AETMIS/Rapports/Cancer/2011_02_res_en.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)