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A systematic review of the impact of volume of surgery and specialization in Norwood procedure.

Pieper D, Mathes T, Asfour B - BMC Pediatr (2014)

Bottom Line: The number of analyzed patients varied from 75 to 2555.Overall, the study quality was moderate with a huge number of items with an unclear risk of bias.The volume-outcome relationship in the Norwood procedure can be supported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str, 200, Building 38, Cologne D- 51109, Germany. dawid.pieper@uni-wh.de.

ABSTRACT

Background: The volume-outcome relationship is supposed to be stronger in high risk, low volume procedures. The aim of this systematic review is to examine the available literature on the effects of hospital and surgeon volume, specialization and regionalization on the outcomes of the Norwood procedure.

Methods: A systematic literature search was performed in Medline, Embase, and the Cochrane Library. On the basis of titles and abstracts, articles of comparative studies were obtained in full-text in case of potential relevance and assessed for eligibility according to predefined inclusion criteria. All relevant data on study design, patient characteristics, hospital volume, surgeon volume and other institutional characteristics, as well as results were extracted in standardized tables. Study selection, data extraction and critical appraisal were carried out independently by two reviewers.

Results: We included 10 studies. All but one study had an observational design. The number of analyzed patients varied from 75 to 2555. Overall, the study quality was moderate with a huge number of items with an unclear risk of bias. All studies investigating hospital volume indicated a hospital volume-outcome relationship, most of them even having significant results. The results were very heterogeneous for surgeon volume.

Conclusions: The volume-outcome relationship in the Norwood procedure can be supported. However, the magnitude of the volume effect is difficult to assess.

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Flow chart.
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Related In: Results  -  Collection

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Figure 1: Flow chart.

Mentions: The search strategy generated 992 hits, of which 10 studies [33,23,42] (11 publications) met our inclusion criteria (see FigureĀ 1). Additional file 3 lists the excluded studies, along with the reasons for exclusion.


A systematic review of the impact of volume of surgery and specialization in Norwood procedure.

Pieper D, Mathes T, Asfour B - BMC Pediatr (2014)

Flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127072&req=5

Figure 1: Flow chart.
Mentions: The search strategy generated 992 hits, of which 10 studies [33,23,42] (11 publications) met our inclusion criteria (see FigureĀ 1). Additional file 3 lists the excluded studies, along with the reasons for exclusion.

Bottom Line: The number of analyzed patients varied from 75 to 2555.Overall, the study quality was moderate with a huge number of items with an unclear risk of bias.The volume-outcome relationship in the Norwood procedure can be supported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str, 200, Building 38, Cologne D- 51109, Germany. dawid.pieper@uni-wh.de.

ABSTRACT

Background: The volume-outcome relationship is supposed to be stronger in high risk, low volume procedures. The aim of this systematic review is to examine the available literature on the effects of hospital and surgeon volume, specialization and regionalization on the outcomes of the Norwood procedure.

Methods: A systematic literature search was performed in Medline, Embase, and the Cochrane Library. On the basis of titles and abstracts, articles of comparative studies were obtained in full-text in case of potential relevance and assessed for eligibility according to predefined inclusion criteria. All relevant data on study design, patient characteristics, hospital volume, surgeon volume and other institutional characteristics, as well as results were extracted in standardized tables. Study selection, data extraction and critical appraisal were carried out independently by two reviewers.

Results: We included 10 studies. All but one study had an observational design. The number of analyzed patients varied from 75 to 2555. Overall, the study quality was moderate with a huge number of items with an unclear risk of bias. All studies investigating hospital volume indicated a hospital volume-outcome relationship, most of them even having significant results. The results were very heterogeneous for surgeon volume.

Conclusions: The volume-outcome relationship in the Norwood procedure can be supported. However, the magnitude of the volume effect is difficult to assess.

Show MeSH