Minimum Volume Standards in Surgery - Are We There Yet?

The quality of surgery is directly dependent on the quantity, more specifically, on the number of operations performed at a given hospital as well as on the designated surgeon. This fact is supported by numerous studies and meta-analyses that will be presented in the following text. Most of the convincing data for complex procedures can be obtained from visceral (upper and lower gastrointestinal) surgery studies. Mortality of large oncological procedures, such as esophageal or pancreatic surgery, can be reduced by 50% if a certain number of interventions are guaranteed per year. Centralizing these operations performed by specialized surgeons is the key to success. This also ensures that the minimum volume amounts within a given hospital are well above the required levels, thus enabling to teach the necessary expertise step by step. The obligatory 'learning curve' for complex interventions cannot be completed within the framework of reference figures during residency training. Together, surgeons and their respective societies have introduced a proposal for efficient case-oriented centralized surgery. Whether 'we are there yet' in surgery will depend in the end on how these efforts will be incorporated into administrative requirements and the guidelines that will then be implemented across the board.