For Some Surgeries It Makes Difference if Hospital Has Performed Them Many Times
Hospitals doing most aortic aneurysm repairs, heart bypass surgeries or gastric bypass surgeries have less adverse events
Sept. 2, 2011 - Seniors scheduled for heart bypass surgery or weight loss surgery may want to find out just how frequently
different hospitals in their area are performing those procedures before deciding where to go. A new study finds that hospitals with higher
surgical volumes for certain procedures are less likely to cause unintentional serious injuries to hospitalized patients when compared to
those hospitals that perform the procedures less often.
“We found a linear relationship between hospital volume and patient safety,” said lead author Tina Hernandez-Boussard,
Ph.D. “That means that the more procedures these hospitals were performing, the lower rates they would have of adverse events.”
Hernandez-Boussard and colleagues are at the Stanford University School of Medicine. The study appears online in the
journal Health Services Research.
The researchers used data from the Nationwide Inpatient Sample discharge database, a large national inpatient database.
They looked at the rates of nine different adverse events in hospitalized patients following three different high-risk procedures — abdominal
aortic aneurysm repair, heart bypass surgery and gastric bypass surgery. Examples of adverse events included blood infections, blood clots
after surgery, postoperative bleeding, accidental punctures and death among surgical patients.
The investigators defined low surgical volume as fewer than 28 procedures per year for abdominal aortic aneurysm, fewer
than 245 for heart bypass surgery and fewer less than 89 for gastric bypass surgery. In almost all instances, hospitals with higher surgical
volume had fewer adverse events than hospitals with low surgical volume.
David Bates, M.D., executive director of the Center for Patient Safety Research and Practice and chief of general
internal medicine at Brigham and Women’s Hospital, said, “One question has been, what’s the minimum number of cases that a hospital needs to
do to be safe? That’s been tricky, because the implication is that below a certain level, hospitals shouldn’t be doing the procedure.” Bates
has no affiliation with the study.
“For a procedure that’s high risk, I think it’s important to do it at a place that does sufficient volume so that you
have the best chance for a good outcome,” Bates said. In addition to the surgeries included in the study, high-risk procedures include
pancreatic cancer surgery, esophageal cancer surgery, complicated birth deliveries and others.
One way that consumers can check how many surgeries a hospital is doing is to consult The Leapfrog Group, a national
advocate of health care safety and quality. The group offers a searchable database that allows consumers to compare individual hospitals on
patient safety and performance. The database is available online at www.leapfroggroup.org/cp. Patients also can ask their surgeon or hospital
directly about surgical procedure volumes.
Original report by Katherine Kahn, Contributing Writer, Health Behavior News Service
Research Source: Health Services Research,
Health Behavior News
Service, Center for Advancing Health
