The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new publications for gastric cancer.
We searched Medline for publications covering the period 1990 to august 2008, and included 13 studies that assessed the impact of hospital or surgeon volume on outcomes such as survival, mortality, complications or quality of life.
Five studies analysed clinical registry data, and eight studies data from administrative databases. Most studies covered treatment given before the year 2000. Studies were from Europe, Holland, Scotland, US and Taiwan.
- Four of five studies reported better survival for patients treated in high volume hospitals. The volume thresholds analysed varied from 13 to 35 procedures per year. One study analysed the impact of surgeon volume for survival of gastric cancer.
- The results from eleven studies that addressed the relationship between hospital volume and in-hospital or 30-day mortality were inconsistent.
- Shortcomings in these studies were differences in patient population between high and low volume hospitals, especially the fact that in several studies low volume hospitals treated more emergency patients.
The incidence of gastric cancer has been reduced over the years, and this also impact volume of procedures in Norwegian hospitals. In 2003 there our national database registered 246 procedures for gastric cancer in 36 hospitals, compared with 187 procedures in 26 hospitals in 2007. The median annual number was 5 all through the period from 2003-2007.
Norwegian Knowledge Centre for the Health Services summarizes and disseminates evidence concerning the effect of treatments, methods, and interventions in health services, in addition to monitoring health service quality. Our goal is to support good decision making in order to provide patients in Norway with the best possible care. The Centre is organized under The Directorate for Health and Social Affairs, but is scientifically and professionally independent. The Centre has no authority to develop health policy or responsibility to implement policies.