• J S Burgers, J Wittenberg, M Kallewaard, J J van Croonenborg, T A van Barneveld, and J J E van Everdingen.
• Kwaliteitsinstituut voor de Gezondheidszorg CBO, Programma Profes-sionele Kwaliteit, Postbus 20.064, 3502 LB Utrecht.
• Ned Tijdschr Geneeskd. 2007 Sep 22;151(38):2105-10.

ObjectiveTo examine the relationship between the number of procedures performed per hospital or per surgeon and health care outcomes.DesignLiterature review.MethodRelevant literature was identified using recent systematic reviews from Germany, England, France and the United States. The Cochrane Library, Medline and Embase were also searched for recent studies (2000-2005) published in German, English, French, or Dutch using the combined search terms 'surgery' and 'volume'; included studies reported mortality or morbidity as measures of health care quality.Results5 systematic reviews were found, which described the results of a total of 41 relevant articles. 8 original articles of sufficient quality published since 2000 were also identified. Most of these articles were also included in the reviews. Relationships between volume per hospital and per surgeon and case fatality (or survival) and morbidity were found for a number of surgical procedures. The strongest associations between volume and case fatality were found for pancreatic and oesophageal resection and, to a lesser degree, elective repair ofabdominal aortic aneurysm. For other procedures the relationship was relatively weak, absent, or not studied.ConclusionVolume appears to be related to quality for some surgical procedures. The magnitude of the relationship differs depending on the procedure. For technically less complex procedures, organisation within the hospital appears to have a greater influence on the differences between hospitals than the performing surgeon.

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