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The relationship of hospital and surgeon volume indicators and post-operative outcomes in pancreatic surgery: a systematic literature review, meta-analysis and guidance for valid outcome assessment.
Fischer, Claudia; Alvarico, Stefanie J; Wildner, B; Schindl, Martin; Simon, Judit.
Afiliação
  • Fischer C; Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria. Electronic address: claudia.fischer@meduniwien.ac.at.
  • Alvarico SJ; Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria.
  • Wildner B; University Library, Medical University of Vienna, Vienna, Austria.
  • Schindl M; Department of Surgery, Comprehensive Cancer Center (CCC), Medical University and Pancreatic Cancer Unit, Vienna, Austria.
  • Simon J; Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom; Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria.
HPB (Oxford) ; 25(4): 387-399, 2023 04.
Article em En | MEDLINE | ID: mdl-36813680
BACKGROUND: Available evidence on the volume-outcome relationship after pancreatic surgery is limited due to the narrow focus of interventions, volume indicators and outcomes considered as well as due to methodological differences of the included studies. Therefore, we aim to evaluate the volume-outcome relationship following pancreatic surgery following strict study selection and quality criteria, to identify aspects of methodological variation and to define a set of key methodological indicators to consider when aiming for comparable and valid outcome assessment. METHODS: Four electronic databases were searched to identify studies on the volume-outcome relationship in pancreatic surgery published between the years 2000-2018. Following a double-screening process, data extraction, quality appraisal, and subgroup analysis, results of included studies were stratified and pooled using random effects meta-analysis. RESULTS: Consistent associations were found between high hospital volume and both postoperative mortality (OR 0.35, 95% CI: 0.29-0.44) and major complications (OR 0.87, 95% CI: 0.80-0.94). A significant decrease in the odds ratio was also found for high surgeon volume and postoperative mortality (OR 0.29, 95%CI: 0.22-0.37). DISCUSSION: Our meta-analysis confirms a positive effect for both hospital and surgeon volume indicators for pancreatic surgery. Further harmonization (e.g. surgery types, volume cut-offs/definition, case-mix adjustment, reported outcomes) are recommended for future empirical studies.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgiões / Hospitais Tipo de estudo: Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: HPB (Oxford) Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgiões / Hospitais Tipo de estudo: Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: HPB (Oxford) Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article