Colorectal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.
Improving the quality and effectiveness of care is a key priority of any health policy. The outcomes of health care can be considered as indicators of effectiveness or quality. The scientific literature that evaluates the association between the volume of activity and the outcome of health interventions has greatly developed over the past decade, but, for practical reasons, ethical and social issues, a few randomized controlled studies were made to evaluate this association, although there are numerous observational studies of outcome and systematic reviews of the studies themselves. The colorectal surgery is the most studied area and it represents the ideal testing ground to determine the effectiveness of the quality indicators because of the high incidence of the disease and the wide spread in the territory of the structures that aim to tackle these issues. Numerous studies have documented an association between the large number of colo-rectal surgical procedures and the quality of results. In particular, the volume of activity is one of the characteristics of measurable process that can have a significant impact on the outcome of health care. In conclusion, the ability to use volume thresholds as a proxy for quality is very tempting but it is only part of reality. Infact, the volume-outcome relationship strictly depends on the type of cancer (colon vs rectum) and it appears somehow stronger for the individual surgeon than for the hospital; especially for the 5-year overall survival, operative mortality and number of permanent stoma.
['Ruffo|Giacomo|G|', 'Barugola|Giuliano|G|', 'Rossini|Roberto|R|', 'Sartori|Carlo Augusto|CA|']
D000068:Accreditation D015179:Colorectal Neoplasms D003107:Colorectal Surgery D013505:Digestive System Surgical Procedures D006801:Humans D007558:Italy D017063:Outcome Assessment, Health Care D062606:Tertiary Care Centers
Colorectal surgery Accreditation Laparoscopy Surgical wards Volumes of surgery