title: Centralization harnessing volume-outcome relationships in vascular surgery and aortic aneurysm care should not focus solely on threshold operative caseload.
abstract: There has been great interest in the setting of threshold operative volumes for safety to guide centralisation of vascular surgical services by healthcare commissioners. This editorial examines the evidence for designing services around a numeric safety threshold in the relationship between volume and outcome in vascular surgery. Thresholds should be aimed at the best outcomes and equity of care. Equity means access to the most up-to-date technology and all the relevant support services for elective and emergency cases. The relationship of volume and outcome with quality is complex, and demands a shift in focus to infrastructural and procedural improvements that drive high-quality services rather than the concentration of planning exclusively around an operative volume threshold.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, Room 4.007, St George's Healthcare NHS Trust, London SW17 0QT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: J D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D002497:Centralized Hospital Services / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*