Abstract
BackgroundThe 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.MethodsMedline, 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.ResultsThirty-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.ConclusionsWhen 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0376-4) contains supplementary material, which is available to authorized users.
Highlights
The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons
Six systematic reviews focus on colorectal cancer [24, 25, 35, 36, 43, 48], three on bariatric surgery [37, 41, 54], two on abdominal aortic aneurysm (AAA) [50, 53], two on esophageal cancer [26, 52], two on radical prostatectomy [47, 51], and two on total knee arthroplasty [38, 45]
Single systematic reviews report on breast cancer [30], on coronary artery bypass graft (CABG) [44], on cystectomy [32], on head and neck cancer [28], on lung cancer [49], on Norwood procedure [42], on pancreatic surgery [31], on percutaneous coronary intervention (PCI) [46], and on trauma [27]
Summary
The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. The existence or nonexistence of surgeon volumeoutcome relationship is important for different issues It can be of importance for the methodological refinement of clinical studies on surgical innovations. The evaluation of innovations vs established procedures can lead to Morche et al Systematic Reviews (2016) 5:204 biased results in terms of the comparison of the effects of the different procedures These trials might overestimate effects for established procedures in comparison to innovations as surgeons are more familiar in performing these surgeries. Such trials might lead to better outcomes for established procedures only due to its longer existence and not due to the procedure itself [6]. There already exist recommendations by the Expert Panel on Weight Loss Surgery [8] for bariatric surgery, and an international expert panel defined appropriate and inappropriate surgeon volumes for a variety of gastric procedures [9]
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