Authors' objectives:

1) to perform a review of the literature of previous experience on the relationship between volume and outcomes;

2) to analyse the data of the CMBDAH 1996-2000 for some cancers and surgical procedures in terms of the volume performed and the relationship with hospital mortality, adjusting for other variables that have an influence (including the Charlson comorbidity index); and

3) to draw up some recommendations that will help to bring about an improvement of equity in terms of diagnosis and therapy and health-care quality.

Authors' results and conclusions: The main outcomes show that the international literature in general advocates the concentration of complex surgical procedures for low-incidence cancers in centres of excellence. In more common cancers, clinical practice guidelines must be drawn up to mainstream the surgical techniques which nowadays seem more frequent in the high-volume centres. The surgical outcomes in our context point to very unequal outcomes in terms of mortality and surgical practice, and it is only in partial hepatectomies and pancreatectomies where the improvement in outcomes (less mortality) is associated, in a statistically significant way, with an increase of the volume of procedures. In the oesophagus, the low-volume centres have a higher mortality than the intermediate or high volume centres. There is also a wide variability in the surgical approach to some oncological processes. Thus, conservative breast surgery, surgery of rectal and anal cancers without colostomy, radical prostatectomies and total gastrectomies are more common in high-volume centres.

Authors' recommendations: Considering the actual outcomes, there is a need to foster, in training and everyday practice, experience and technical skills. Information systems must be developed which, by straddling the whole healthcare process, will make it possible to assess outcomes in a way that fits patient complexity better, while bringing in, in turn, other outcome measures. This information should be disseminated to promote more informed decisions.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)