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Stanak, M. and Strohmaier, C. (2019): Minimum volume standards for quality assurance in day surgery: Fundamentals and Systematic Review. HTA-Projektbericht 125.

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Abstract

The challenge of providing comprehensive health care of high quality that is available to all is shared by the universal coverage health care systems of today. A possible measure for quality assurance in day surgery is minimum volume standards (MVSs). While the majority of research in this context observes a positive relationship between volume and outcome in the form of statistical correlation, the data availability on surgery specific and evidence-based minimum volume thresholds is low. Aims of the present report were to show the fundamentals of the MVSs theory, to illustrate possible internationally implemented MVSs frameworks in day surgery, and (in the course of a systematic review) to examine whether MVSs for specific day surgeries lead to better results in terms of efficacy and safety.

The systematic literature search was conducted in five databases. After deduplication, overall 538 citations were found via systematic searching and an additional 57 by a hand search – resulting in the total of 595 hits. In addition, an exploratory literature search for the section on minimum volume standards and the volume-outcome relationship was carried out. Furthermore, a hand search in websites of governmental and public bodies, expert societies, and other stakeholders in the health care system was carried out.

For the assessment of clinical effectiveness, eight studies -which reported seven different interventions- met the inclusion criteria. The interventions at stake in the current assessment were not predefined, but were selected based upon the systematic literature search. The indications are thyroid surgery (thyroidectomy), cataract surgery, primary hip arthroscopy, open carpal tunnel release, rotator cuff repair, anterior cruciate ligament reconstruction, and meniscectomy. The only safety related data reported were without its relationship to surgeon/hospital volume. Other important chapters of the report were devoted to the theory of MVSs, the current use of MM with a special focus on the German context and the definition of the day surgery setting.

There is no consensus behind the theory of MVSs and the results from our systematic review cannot offer any clear-cut MVS thresholds. This present report, however, provides some evidence in favour of a volume-outcome relationship (VOR), even though it is based on low quality retrospective data-analyses. Against this background, we recommend that the use of MVSs should be well thought through. Moreover, because establishing a VOR -and subsequently a MVSs- is possible, more quality prospective controlled evidence for the day surgery setting is required. Also, other quality assurance measures such as standards focusing on process and outcome quality should be taken into account.

Item Type:Project Report
Keywords:Minimum volume standards, volume-outcome relationship, day surgery, ambulatory surgery, quality standards, quality assurance
Subjects:WA Public health > WA 525-590 Health administration and organisation
WO Surgery > WO 500-517 Operative surgical procedures. Techniques
W Health professions > W 74-80 Medical economics. Health care costs
WB Practice of medicine > WB 102 Evidence-based medicine
W Health professions > W 84 Health services. Quality of health care
Language:English
Series Name:HTA-Projektbericht 125
Deposited on:18 Dec 2019 13:19
Last Modified:18 Dec 2019 13:19

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