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We allocated consultants to volume bands in a similar fashion, but because surgeons could operate at more than one institution, and hence be included in more than one institutional volume band, allocation was done in two stages.
This trend of passing costs to the public could be reversed with institutional volume purchases.
Key points: institutional volume Minimum centre volume is 400 cases/year.
Similar results were seen when the researchers accounted for institutional volume.
Differences in the structural and process of care variables were significant across the bands for institutional volume (table 4).
We recommend that the number of trainees accepted into a training programme should reflect the institutional volume and the number of senior trainers available.
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13 Institutional structural variables can attenuate the volume-mortality relation by up to 59%. 12 Interpretation of the institutional volume-mortality relation reported in this study was only possible after adjustment for institutional structural and process of care variables.
The focus in debates about centralization is usually institutional volumes.
Institutional volumes are not necessarily related to the caseload of the individual surgeons.
This can be a focus in all neurosurgical centres, regardless of institutional volumes.
The impact of overall uro-oncological operative volumes has been highlighted and, for cystectomy, adjustment for institutional volumes of nephrectomies and prostatectomies attenuated the institutional cystectomy volume-mortality relation by 60%.
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