Research question:

The aims of this investigation are to

– present and assess the relationship between volume of services (VoS) and quality of treatment outcome in complex oesophageal interventions (research question 1),

– present studies which investigate the extent to which the quality of treatment outcome is impacted by minimum numbers of cases introduced in the healthcare system for complex oesophageal interventions (research question 2).

As supplementary information, the surgical procedures included in and excluded from the studies considered relevant are described in detail.

Conclusion:

For the investigation of the relationship between VoS and quality of treatment outcome in complex oesophageal interventions (research question 1), a total of 37 observational studies were included, of which 30 contained usable data. Only 1 study had a high informative value of results.

For hospital VoS, a correlation between VoS and quality of treatment outcome was found for several operationalizations regarding the outcome of mortality. For the outcome of treatment-related complications (anastomotic insufficiency), likewise, a correlation was found between VoS and quality of treatment outcome on the basis of a study with high informative value of results. A correlation was also found with regard to the outcome of failure to rescue. For the additionally defined outcome of rehospitalization, a study with low informative value of results revealed a correlation between VoS and quality of treatment outcome to the disadvantage of high-VoS hospitals.

Regarding physician VoS, for the outcome of mortality, a correlation between VoS and quality of treatment outcome was found only for the operationalization of inpatient mortality. For the outcome of treatment-related complications (anastomotic insufficiency), a study of high informative value of results likewise showed a correlation between VoS and quality of treatment outcome.

No studies of meaningful interpretive value were found to investigate the extent to which the quality of treatment outcome is impacted by specific minimum numbers of cases introduced in the healthcare system for complex oesophageal interventions (research question 2).

Publisher

Institute for Quality and Efficiency in Health Care

Topic

Relationship between volume of services and quality of treatment outcome for complex oesophageal interventions

Commissioning agency

Federal Joint Committee

Commission awarded on

18 April 2019

Internal Commission No.

V19-04

Address of publisher

This report was prepared in collaboration with external experts and underwent an external review.

The responsibility for the contents of the report lies solely with IQWiG.

According to §139b (3) No. 2 of Social Code Book (SGB) V, Statutory Health Insurance, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established to assess conflicts of interests. The information on conflicts of interest provided by the external experts and external reviewers is presented in Appendix D of the full report. No conflicts of interest were detected that could endanger professional independence with regard to the work on the present commission.

External expert

• Thomas Schmidt, Clinic for General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany

External review of the preliminary report

• Christiane Bruns, Clinic and Polyclinic for General, Visceral, Tumour and Transplant Surgery, University Hospital Cologne, Germany

IQWiG thanks the external expert and external reviewer for their collaboration in the project.

IQWiG employees

• Wiebke Hoffmann-Eßer
• Lutz Altenhofen
• Carmen Bartel
• Ralf Bender
• Mandy Kromp
• Christoph Mosch
• Wiebke Sieben
• Dorothea Sow