Observational studyBMJ open2017
Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014.
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
64 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Volume-outcome relationship in corrective surgery for Hirschsprung's disease: a systematic literature review of direct evidence and an overview of indirect evidence.Pediatric surgery international · 2025Pooled it
- Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Regionalization for health improvement: A systematic review.PloS one · 2020Pooled it
- The volume-outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients.Acta orthopaedica · 2019Pooled it
- Article
- Optimized surgical treatment and study management for oncology patients in East Saxony (MISSION4Sax): study protocol of a multicentre pilot study.Journal of cancer research and clinical oncology · 2026Article
- The volume-outcome relationship for incisional hernia repair: analysis of an administrative dataset for England.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- [Operations for benign thyroid gland diseases in Germany-Development of case numbers and complication rates over the course of 10 years].Chirurgie (Heidelberg, Germany) · 2026Observational
- Effects of First Time Minimum Volume Regulation on the Surgical Treatment of Lung Cancer in Germany.Cancers · 2026Article
- Investigating non-linear volume-outcome relationships in total knee arthroplasty based on a sample of more than 60,000 hospital cases from Germany, 2020-2023.Scientific reports · 2026Article
- Variation in patient-reported outcomes after total hip replacement across ten high-volume hospitals in Germany: results from a multicenter, prospective, longitudinal Cohort Study.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Regionalization of Hip Fracture Care in Five High-Income Countries.Health services research · 2025Article
- High-volume hospitals do not perform better than low-volume hospitals in septic and aseptic revision total hip arthroplasty: an analysis of re-revision risk and mortality based on the Dutch Arthroplasty Register.Acta orthopaedica · 2025Article
- Is the annual hospital volume associated with recurrence and chronic postoperative inguinal pain (CPIP) syndrome after inguinal hernia repair in laparo-endoscopic or open mesh technique (Lichtenstein)?Surgical endoscopy · 2025Article
- The elicitation of patient preferences for hip replacement surgery: a discrete choice experiment.BMC health services research · 2025Article
- Regional variation in access to and quality of acute stroke care: results of Germany's Health System Performance Assessment pilot, 2014-2020.Research in health services & regions · 2024Article
- Article
- [Recommendations for the specialist further training of nursing personnel on intensive care units in the treatment of abdominal aortic aneurysms: results of a modified Delphi procedure with experts].Chirurgie (Heidelberg, Germany) · 2024Article
- Long segment stenosis-the narrow path to centralization in airway surgery.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Treatment in certified cancer centers is related to better survival in patients with colon and rectal cancer: evidence from a large German cohort study.World journal of surgical oncology · 2024Article
4 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo explore the existence and strength of a relationship between hospital volume and mortality, to estimate minimum volume thresholds and to assess the potential benefit of centralisation of services.
designObservational population-based study using complete German hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)).
settingAll acute care hospitals in Germany.
participantsAll adult patients hospitalised for 1 out of 25 common or medically important types of inpatient treatment from 2009 to 2014.
main outcome measureRisk-adjusted inhospital mortality.
resultsLower inhospital mortality in association with higher hospital volume was observed in 20 out of the 25 studied types of treatment when volume was categorised in quintiles and persisted in 17 types of treatment when volume was analysed as a continuous variable. Such a relationship was found in some of the studied emergency conditions and low-risk procedures. It was more consistently present regarding complex surgical procedures. For example, about 22 000 patients receiving open repair of abdominal aortic aneurysm were analysed. In very high-volume hospitals, risk-adjusted mortality was 4.7% (95% CI 4.1 to 5.4) compared with 7.8% (7.1 to 8.7) in very low volume hospitals. Theminimum volume above which risk of death would fall below the average mortality was estimated as 18 cases per year. If all hospitals providing this service would perform at least 18 cases per year, one death among 104 (76 to 166) patients could potentially be prevented.
conclusionsBased on complete national hospital discharge data, the results confirmed volume-outcome relationships for many complex surgical procedures, as well as for some emergency conditions and low-risk procedures. Following these findings, the study identified areas where centralisation would provide a benefit for patients undergoing the specific type of treatment in German hospitals and quantified the possible impact of centralisation efforts.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.