For Release: 5 p.m. ET, April 10, 2002
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Older Patients Who Need High-Risk Heart or Cancer Surgery Fare Better in Hospitals Experienced in Those Procedures
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The research, sponsored by the Agency for Healthcare Research and Quality (AHRQ), was led by John D. Birkmeyer, MD, associate professor of surgery and a general surgeon at Dartmouth-Hitchcock Medical Center.
The most experienced hospitals are those with the highest volume of procedures. Going to one made the biggest difference for patients undergoing surgery for cancer of the pancreas: only 3.8 percent of such patients at the highest volume hospitals died, compared to 16.3 percent at lowest volume hospitals -- a 12.5 percentage point variance. Death rates differed to a similar degree for patients undergoing surgery for cancer of the esophagus (8 percent at highest volume hospitals vs. 20 percent at lowest volume hospitals).
The Dartmouth study also found that older patients fared better at high volume hospitals when undergoing heart valve replacement, abdominal aneurysm repair, and surgery for lung, stomach or bladder cancer. For each of these procedures, death rates at the highest volume hospitals were between two percent and five percent lower than at the lowest volume hospitals.
Hospital volume was least important for patients having coronary artery bypass surgery, carotid endarterectomy (an operation to prevent stroke) and surgery for colon or kidney cancer; death rates at highest and lowest volume hospitals differed by less than two percentage points.
Each year in the US more than 20,000 elderly patients die undergoing one of these 14 high-risk operations that are often elective. More than 1,000 of these deaths could be averted if patients at the lowest volume hospitals had surgery instead at the highest volume centers, Birkmeyer says.
He and his colleagues believe the results reflect real differences in quality because the effect -- particularly for some procedures -- is large and consistent over time. They conclude, "In the absence of better information about surgical quality, patients undergoing many procedures can substantially improve their survival odds by selecting a high volume hospital near them."
The nationwide study examined outcomes in approximately 2.5 million Medicare patients (at least 65 years old) who had surgery between 1994 to 1999, and focused on total hospital volume, not total Medicare volume. It used data from the national Medicare database and AHRQ's Healthcare Cost and Utilization Project.
Co-authors of the article, "Hospital Volume and Surgical Mortality in the United States," include: Emily V. A. Finlayson, MD, Therese A. Stukel, PhD, H. Gilbert Welch, MD, MPH, David E. Wennberg, MD, MPH, Andrea E. Siewers, MPH, F. Lee Lucas, PhD, and Ida Batista.
