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International Study Finds Lower Mortality with Larger Case Volumes for Complex Pancreatic Surgery

For certain surgical procedures, can a correlation be shown between the volume of services provided per hospital and the quality of treatment results? This is the question addressed in eight commissions that the Federal Joint Committee (G-BA) awarded to the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany. An IQWiG rapid report is now available for the seventh intervention to be tested, complex pancreatic surgery.

According to the findings, for complex pancreatic surgery a positive correlation can be inferred between the volume of services and the quality of treatment results: In hospitals with larger case volumes, the survival probabilities for patients are higher overall, fewer fatal complications occur and hospital stays are mostly shorter.

Between 2009 and 2014, about 35,000 complex surgical procedures of the pancreas were performed overall in Germany due to malignant neoplasms. The hospital mortality rates for patients who underwent complex pancreatic surgery in Germany between 2009 and 2013 were around 10 percent. The G-BA has set a minimum volume for complex pancreatic surgery in Germany, which currently stands at ten procedures per year and hospital location.

The IQWiG project team identified 42 retrospective observational studies investigating the correlation between the volume of services and the quality of treatment results in complex pancreatic surgery. Of these studies, 36 contained usable data. The data analysis showed that the overall survival probabilities for patients who undergo pancreatic surgery are higher when they are treated in hospitals with larger case volumes and by surgeons with more routine in this type of surgery.

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