High Risk Surgeries Demand High Volume Hospitals and High Volume Surgeons

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High Volume Hospitals vs. Low Volume Hospitals

Practice makes perfect. Learn by doing. The more you do the better you get. If you’ve ever played a sport or picked up an instrument or had to learn cursive writing, you’ve heard the same adages that extol the benefits of repeating the same process over and over as the best way to improve your outcome.   So why is it then, that when it comes to a high risk surgeries, like those for lung, esophageal, pancreatic or rectal cancers, or aortic aneurysm repair, carotid endarterectomy, bariatric surgery, or mitral valve repairs, patients forget these time honored idioms? After all, not all hospitals are the same and when it comes to high risk surgeries, good enough isn’t good enough.

There is strong and abundant data to confirm that patients who chose a surgeon and hospital with vast experience in a procedure get better results than those patients whose surgery is done at a hospital or by a surgeon without high volume experience with the procedure. In fact, a 2015 U.S. News and World Reports analysis estimated that in just three years, nearly 11,000 patients may have been saved had they been attended to at a “highest volume hospital,” rather than a “lowest volume hospital,” for their procedure.

It makes perfect common sense. Doctors and nurses and hospitals who treat a particular condition regularly develop the skills and instincts and experiences that low volume providers lack, which gives the patient a better chance of surviving.

Leapfrog Survey of Hospitals Locally

In 2018, a Leapfrog survey asked hospitals to report on whether they perform a sufficient volume of a small, defined list of high risk procedures and whether surgeons are required to demonstrate an adequate volume to be privileged to perform each procedure. The results in the Lancaster, PA area are disappointing in that no local hospital (Lancaster General, Hershey Medical Center, York Hospital, UPMC Harrisburg, UPMC Community, UPMC Pinnacle Lititz, UPMC Westshore, Wellspan Ephrata, and Wellspan Good Samaritan), meets the Leapfrog standards for all the high risk surgeries, and only Hershey Medical Center meets the standard for any high risk procedure other than bariatric surgery.  According to the Leapfrog study, no local hospital meets the standards for carotid artery surgery or cancer surgery for lung, esophageal or pancreatic cancer.

But these results are not abnormal when compared nationally. The Leapfrog survey reveals that the vast majority of hospitals do not meet Leapfrog minimum hospital and surgeon volume standards for the eight (8) high risk surgical procedures.  As in the Lancaster area, the procedure for which the most hospitals meet both the minimum set hospital volume standard (50 surgeries per year) and the minimum surgeon volume (20 surgeries per year) was bariatric surgery for weight loss, and only 38% met both standards.   Abdominal aortic repair and esophageal resection for cancer had the lowest numbers of hospitals meeting the Leapfrog standards – only 2.6% and 2.5%, respectively.

Nationwide Leapfrog Survey Findings

What’s even more astounding is that nationally, the survey found that for each of the procedures other than bariatric surgery, less than 1 out of 5 hospitals enforce adequate minimum volume requirements for surgeons to obtain or retain privileges to perform that surgery. Not surprisingly, the likelihood of an urban hospital maintaining adequate procedure volumes to produce better outcomes for patients of high risk procedures is significantly better than rural hospitals. The urban hospitals also do a better job of confirming the medical necessity of a procedure, which is important when data suggests that up to one third of procedures are performed without medical necessity.

So what does this all mean? The Leapfrog results clearly reflect that, “[p]atients can achieve a better outcome by choosing a hospital and a surgeon with adequate ongoing experience performing that surgery.” Patients undergoing high-risk procedures have a higher risk for medical errors, complications and death with lower volume providers. See the Leapfrog survey results for more information and to compare hospitals.