title: [The centralisation of highly complex operations].
abstract: The relationship between hospital volume and outcome of care after pancreatic surgery, particularly mortality, has been described extensively in the past. Today, this relationship is frequently being used by healthcare providers and/or insurance companies to select hospitals for various surgical procedures. This concept, however, has many limitations. The conceptual model concerning the relationship between how hospital facilities are arranged and the different aspects of the process of providing healthcare is discussed in three case histories describing complicated postoperative courses after pancreatic resections. The conclusion is that, besides hospital volume, the manner in which the various facilities in hospitals are arranged as well as the process of care giving, particularly the effectiveness of multidisciplinary meetings, are of crucial importance to the quality of care. Data per illness, with adequate correction for case mix, are of crucial importance for comparing the differences in quality of care between hospitals.
authors.affiliation: Academisch Medisch Centrum, Afd. Chirurgie, Amsterdam, the Netherlands. d.j.gouma@amc.uva.nl
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Han J S
authors.initials: HJ
authors.lastname: Laméris
authors.forename: Eric A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007350:Insurance, Hospitalization / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care