[Centralization on fewer surgeons--an example from gastric surgery].
BACKGROUND
Previous studies have shown an association between surgical volume and a decreased mortality rate for departments as a whole as well as for individual surgeons. The background for this study was to investigate whether it would be beneficial to centralize gastric surgery, not only in fewer departments but also in fewer hands in the department.


METHODS
The study was based on the patient records of the 93 patients operated between 1 January 2000 and 1 September 2005. The surgeons were divided into two groups based on whether they had performed more than 15 or less than 5 operations during the period.


RESULTS
Of the 93 operations, 3 surgeons performed 80 and 7 surgeons performed the remaining 13 operations. The mortality was significantly increased in patients operated by surgeons with a low operation volume, p = 0.0004. The 12 acute operations were performed as often by a surgeon with low operation volume as by a surgeon with high operation volume. Again, mortality increased when the operation was performed by a surgeon with low operation volume, p = 0.015.


CONCLUSIONS
The results argue for a centralization of gastric resections on a few surgeons and for an organisation of acute surgery so that these procedures are performed by only a few experienced surgeons.
Munksgaard
Signe Bruun
SB
Gentofte Hospital, Kirurgisk Gastroenterologisk Afdeling, Hellerup. signe@direkte.org
Fischer
Anders
A
Rosenberg
Jacob
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002497:Centralized Hospital Services / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence; D004630:Emergencies; D005260:Female; D005743:Gastrectomy / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D005763:Gastroenterostomy / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000601:surgery; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data