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Toward a Consensus on Centralization in Surgery.

Artikel i vetenskaplig tidskrift
Författare René Vonlanthen
Peter Lodge
Jeffrey S Barkun
Olivier Farges
Xavier Rogiers
Kjetil Soreide
Henrik Kehlet
John V Reynolds
Samuel A Käser
Peter Naredi
Inne Borel-Rinkes
Sebastiano Biondo
Hugo Pinto-Marques
Michael Gnant
Philippe Nafteux
Miroslav Ryska
Wolf O Bechstein
Guillaume Martel
Justin B Dimick
Marek Krawczyk
Attila Oláh
Antonio D Pinna
Irinel Popescu
Pauli A Puolakkainen
Georgius C Sotiropoulos
Erkki J Tukiainen
Henrik Petrowsky
Pierre-Alain Clavien
Publicerad i Annals of surgery
Volym 268
Nummer/häfte 5
Sidor 712-724
ISSN 1528-1140
Publiceringsår 2018
Publicerad vid
Sidor 712-724
Språk en
Länkar dx.doi.org/10.1097/SLA.000000000000...
Ämneskategorier Klinisk medicin


To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.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.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.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.

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