Austrian Institute for Health Technology Assessment (former Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria.
Department of Philosophy, University of Vienna, Vienna, Austria.
BMC Health Serv Res. 2020 Sep 18;20(1):886. doi: 10.1186/s12913-020-05724-2.
The aim was to find out if and for what indications are minimum volume standards (MVS) applied in the day surgery setting and whether the application of MVS improves patient relevant outcomes.
We conducted a comprehensive systematic literature search in seven databases on July 12th, 2019. Concerning effectiveness and safety, the data retrieved from the selected studies were systematically extracted into data-extraction tables. Two independent researchers (MS, CS) systematically assessed the quality of evidence using the quality assessment tool for individual studies of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) called Task Force Checklist for Quality Assessment of Retrospective Database Studies. No instances of disagreement occurred. No further data processing was applied.
The systematic literature search, together with hand search, yielded 595 hits. No prospective or controlled studies were found. Data from eight retrospective studies were used in the analysis of clinical effectiveness and safety on seven indications: anterior cruciate ligament reconstruction, cataract surgery, meniscectomy, thyroidectomy, primary hip arthroscopy, open carpal tunnel release, and rotator cuff repair. All interventions (except for carpal tunnel release and thyroidectomy) confirmed a volume-outcome relationship (VOR) with relation to surgeon/hospital volume, however, none established MVS for the respective interventions. Safety related data were reported without its relationship to surgeon/hospital volume.
This present paper provides some evidence in favor of the VOR, however, it based on low quality retrospective data-analyses. The present results cannot offer any clear-cut MVS thresholds for the day surgery setting and so the simple transition from inpatient results (that support MVS) to the day surgery setting is questionable. Further quality assuring policy approaches should be considered.
本研究旨在探讨日间手术中是否以及在哪些适应证下应用最小容量标准（MVS），以及应用 MVS 是否能改善患者相关结局。
我们于 2019 年 7 月 12 日在七个数据库中进行了全面的系统文献检索。关于有效性和安全性，从选定研究中检索到的数据被系统地提取到数据提取表中。两名独立的研究人员（MS、CS）使用国际药物经济学和结果研究学会（ISPOR）的个体研究质量评估工具——回顾性数据库研究质量评估任务组检查表，对证据质量进行了系统评估。没有出现意见分歧。没有进一步的数据处理。
系统文献检索与手工检索共得到 595 个结果。没有发现前瞻性或对照研究。对七种适应证（前交叉韧带重建、白内障手术、半月板切除术、甲状腺切除术、髋关节初次关节镜检查、开放腕管松解术和肩袖修复术）的七项临床有效性和安全性研究的数据进行了分析。所有干预措施（除腕管松解术和甲状腺切除术外）均证实了与外科医生/医院容量相关的容量-结局关系（VOR），但没有为各自的干预措施确定 MVS。安全性相关数据是在没有报告其与外科医生/医院容量关系的情况下报告的。
本研究提供了一些支持 VOR 的证据，但这些证据基于低质量的回顾性数据分析。目前的结果不能为日间手术设定提供明确的 MVS 阈值，因此，将住院结果（支持 MVS）简单地应用于日间手术设定是值得怀疑的。应考虑进一步的质量保证政策方法。
