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Toward a Consensus on Centralization in Surgery

2018Journal article Open access
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dc.contributor.authorVonlanthen, R
dc.contributor.authorLodge, P
dc.contributor.authorBarkun, J
dc.contributor.authorFarges, O
dc.contributor.authorRogiers, X
dc.contributor.authorSoreide, K
dc.contributor.authorKehlet, H
dc.contributor.authorReynolds, J
dc.contributor.authorKäser, S
dc.contributor.authorNaredi, P
dc.contributor.authorBorel-Rinkes, I
dc.contributor.authorBiondo, S
dc.contributor.authorPinto Marques, H
dc.contributor.authorGnant, M
dc.contributor.authorNafteux, P
dc.contributor.authorRyska, M
dc.contributor.authorBechstein, W
dc.contributor.authorMartel, G
dc.contributor.authorDimick, J
dc.contributor.authorKrawczyk, M
dc.contributor.authorOláh, A
dc.contributor.authorPinna, A
dc.contributor.authorPopescu, I
dc.contributor.authorPuolakkainen, P
dc.contributor.authorSotiropoulos, G
dc.contributor.authorTukiainen, E
dc.contributor.authorPetrowsky, H
dc.contributor.authorClavien, PA
dc.date.accessioned2022-05-13T15:13:44Z
dc.date.available2022-05-13T15:13:44Z
dc.date.issued2018
dc.description.abstractObjectives: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAnn Surg. 2018 Nov;268(5):712-724.pt_PT
dc.identifier.doi10.1097/SLA.0000000000002965.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4081
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherWolters Kluwer Healthpt_PT
dc.subjectHCC CIRpt_PT
dc.subjectEuropept_PT
dc.subjectHumanspt_PT
dc.subjectCentralized Hospital Services / trends*pt_PT
dc.subjectConsensuspt_PT
dc.subjectEducation, Medical / trendspt_PT
dc.subjectHealth Policy / trends*pt_PT
dc.subjectNorth Americapt_PT
dc.subjectQuality Assurance, Health Care*pt_PT
dc.subjectSurgical Procedures, Operative*pt_PT
dc.titleToward a Consensus on Centralization in Surgerypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage724pt_PT
oaire.citation.startPage712pt_PT
oaire.citation.titleAnnals of Surgerypt_PT
oaire.citation.volume268pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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