Toward a Consensus on Centralization in Surgery

René Vonlanthen; Peter Lodge; Jeffrey S Barkun; Olivier Farges; Xavier Rogiers; Kjetil Soreide; Henrik Kehlet; John V Reynolds; Samuel A Käser; Peter Naredi; Inne Borel-Rinkes; Sebastiano Biondo; Hugo Pinto-Marques; Michael Gnant; Philippe Nafteux; Miroslav Ryska; Wolf O Bechstein; Guillaume Martel; Justin B Dimick; Marek Krawczyk; Attila Oláh; Antonio D Pinna; Irinel Popescu; Pauli A Puolakkainen; Georgius C Sotiropoulos; Erkki J Tukiainen; Henrik Petrowsky; Pierre-Alain Clavien

doi:10.1097/SLA.0000000000002965

Toward a Consensus on Centralization in Surgery

René Vonlanthen, Peter Lodge, Jeffrey S Barkun, Olivier Farges, Xavier Rogiers, Kjetil Soreide, Henrik Kehlet, John V Reynolds, Samuel A Käser, Peter Naredi, Inne Borel-Rinkes, Sebastiano Biondo, Hugo Pinto-Marques, Michael Gnant, Philippe Nafteux, Miroslav Ryska, Wolf O Bechstein, Guillaume Martel, Justin B Dimick, Marek KrawczykAttila Oláh, Antonio D Pinna, Irinel Popescu, Pauli A Puolakkainen, Georgius C Sotiropoulos, Erkki J Tukiainen, Henrik Petrowsky, Pierre-Alain Clavien

Department of Clinical Medicine

49 Citations (Scopus)

Abstract

OBJECTIVES: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.

BACKGROUND/METHODS: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents.

RESULTS: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education.

CONCLUSION/RECOMMENDATIONS: There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.

Original language	English
Journal	Annals of Surgery
Volume	268
Issue number	5
Pages (from-to)	712-724
Number of pages	13
ISSN	0003-4932
DOIs	https://doi.org/10.1097/SLA.0000000000002965
Publication status	Published - 2018

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Vonlanthen, R., Lodge, P., Barkun, J. S., Farges, O., Rogiers, X., Soreide, K., Kehlet, H., Reynolds, J. V., Käser, S. A., Naredi, P., Borel-Rinkes, I., Biondo, S., Pinto-Marques, H., Gnant, M., Nafteux, P., Ryska, M., Bechstein, W. O., Martel, G., Dimick, J. B., ... Clavien, P-A. (2018). Toward a Consensus on Centralization in Surgery. Annals of Surgery, 268(5), 712-724. https://doi.org/10.1097/SLA.0000000000002965

Vonlanthen, R, Lodge, P, Barkun, JS, Farges, O, Rogiers, X, Soreide, K, Kehlet, H, Reynolds, JV, Käser, SA, Naredi, P, Borel-Rinkes, I, Biondo, S, Pinto-Marques, H, Gnant, M, Nafteux, P, Ryska, M, Bechstein, WO, Martel, G, Dimick, JB, Krawczyk, M, Oláh, A, Pinna, AD, Popescu, I, Puolakkainen, PA, Sotiropoulos, GC, Tukiainen, EJ, Petrowsky, H & Clavien, P-A 2018, 'Toward a Consensus on Centralization in Surgery', Annals of Surgery, vol. 268, no. 5, pp. 712-724. https://doi.org/10.1097/SLA.0000000000002965

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title = "Toward a Consensus on Centralization in Surgery",

abstract = "OBJECTIVES: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.BACKGROUND/METHODS: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents.RESULTS: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education.CONCLUSION/RECOMMENDATIONS: There is an obvious need in most areas for effective centralization. Unrestrained, purely {"}market driven{"} approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.",

author = "Ren{\'e} Vonlanthen and Peter Lodge and Barkun, {Jeffrey S} and Olivier Farges and Xavier Rogiers and Kjetil Soreide and Henrik Kehlet and Reynolds, {John V} and K{\"a}ser, {Samuel A} and Peter Naredi and Inne Borel-Rinkes and Sebastiano Biondo and Hugo Pinto-Marques and Michael Gnant and Philippe Nafteux and Miroslav Ryska and Bechstein, {Wolf O} and Guillaume Martel and Dimick, {Justin B} and Marek Krawczyk and Attila Ol{\'a}h and Pinna, {Antonio D} and Irinel Popescu and Puolakkainen, {Pauli A} and Sotiropoulos, {Georgius C} and Tukiainen, {Erkki J} and Henrik Petrowsky and Pierre-Alain Clavien",

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language = "English",

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TY - JOUR

T1 - Toward a Consensus on Centralization in Surgery

AU - Vonlanthen, René

AU - Lodge, Peter

AU - Barkun, Jeffrey S

AU - Farges, Olivier

AU - Rogiers, Xavier

AU - Soreide, Kjetil

AU - Kehlet, Henrik

AU - Reynolds, John V

AU - Käser, Samuel A

AU - Naredi, Peter

AU - Borel-Rinkes, Inne

AU - Biondo, Sebastiano

AU - Pinto-Marques, Hugo

AU - Gnant, Michael

AU - Nafteux, Philippe

AU - Ryska, Miroslav

AU - Bechstein, Wolf O

AU - Martel, Guillaume

AU - Dimick, Justin B

AU - Krawczyk, Marek

AU - Oláh, Attila

AU - Pinna, Antonio D

AU - Popescu, Irinel

AU - Puolakkainen, Pauli A

AU - Sotiropoulos, Georgius C

AU - Tukiainen, Erkki J

AU - Petrowsky, Henrik

AU - Clavien, Pierre-Alain

PY - 2018

Y1 - 2018

N2 - OBJECTIVES: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.BACKGROUND/METHODS: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents.RESULTS: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education.CONCLUSION/RECOMMENDATIONS: There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.

AB - OBJECTIVES: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.BACKGROUND/METHODS: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents.RESULTS: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education.CONCLUSION/RECOMMENDATIONS: There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.

U2 - 10.1097/SLA.0000000000002965

DO - 10.1097/SLA.0000000000002965

M3 - Journal article

C2 - 30169394

SN - 0003-4932

VL - 268

SP - 712

EP - 724

JO - Advances in Surgery

JF - Advances in Surgery

IS - 5

ER -

Toward a Consensus on Centralization in Surgery

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