Hospitals Performing Large Number of Surgeries Have Fewer Complications, Deaths, Studies Say

Hospitals that perform a large number of certain surgeries have fewer complications and deaths than facilities that perform the operations less often, according to two studies in the April 11 New England Journal of Medicine, the New York Times reports. In the first study, funded by the Agency for Healthcare Research and Quality, researchers led by Dr. John Birkmeyer of Dartmouth Medical School examined 2.5 million Medicare claims for beneficiaries who underwent one of six cardiovascular operations or eight cancer operations between 1994 and 1999. According to the study, "low-volume" hospitals, which performed fewer of the 14 procedures, had mortality rates 0.2% to 12% higher than "high-volume" hospitals (Villarosa, New York Times, 4/11). The study found, for example, that only 4% of Medicare beneficiaries who underwent surgery for cancer of the pancreas at high-volume hospitals died, compared to 16% at the low-volume hospitals. The study also found that only 8% of Medicare beneficiaries who underwent surgery for cancer of the esophagus died at high-volume hospitals, compared with 20% at low-volume hospitals (AHRQ release, 4/10). The study divided hospitals into five volume groups, based on number of procedures in various categories (NEJM, 4/11).

Second Study
In the second study, researchers at the Memorial Sloan-Kettering Cancer Center in New York City examined 11,522 men who had their prostates removed between 1992 and 1996 as a result of cancer (AP/Washington Post, 4/11). The study found no significant difference in mortality rates among patients who underwent the surgery at low-volume and high-volume hospitals. However, patients who underwent the surgery at high-volume hospitals had significantly fewer complications after surgery (Begg et al., NEJM, 4/11). In an editorial accompanying the studies, Dr. Arnold Epstein, chair of the department of health policy and management at the Harvard School of Public Health, wrote, "It's time to move ahead carefully and judiciously and increase the proportion of care provided in high-volume centers." However, the New York Times reports that the "importance of volume is still a matter of debate." Dr. Don Nielsen, senior vice president of the American Hospital Association, said, "Volume is an indicator, but a very crude indicator, or the quality of care a patient may receive. The experience of the institution, the experience of the physician, the team that supports the physician and the distance from the patient's home are all important" (New York Times, 4/11).