Mortality Rates Lower Among High-Volume Surgeons, Study Finds
The volume of procedures performed by individual surgeons may have a greater impact on patient mortality rates than the volume of procedures performed in a hospital, according to a study published last week in the New England Journal of Medicine, the Wall Street Journal reports. To conduct the study, Dr. John Birkmeyer, chief of general surgery at Dartmouth-Hitchcock Medical Center and a consultant for the Leapfrog Group, and colleagues analyzed the records of about 475,000 Medicare patients at hospitals nationwide in 1998 and 1999. The patients underwent one of eight different cancer and cardiovascular procedures, and researchers analyzed which patients died before they were discharged or within 30 days of surgery (Tomsho, Wall Street Journal, 11/28). Researchers found that for most procedures, mortality rates were higher among patients of surgeons that had performed fewer procedures than among those of surgeons who had performed high numbers of procedures, regardless of the surgical volume of the hospital (Birkmeyer et al., New England Journal of Medicine, 11/27). For example, for aortic-valve replacement procedures, the mortality rate for patients with surgeons who performed 22 or fewer procedures per year was 10.2%, compared with 6.1% among patients whose surgeons conducted 42 or more procedures per year (Wall Street Journal, 11/28). According to the study, patients were "much more likely" to receive surgery from a low-volume surgeon if they went to a low-volume hospital than if they went to a high-volume hospital (New England Journal of Medicine, 11/27). Birkmeyer said the study shows that "processes of care under the control of surgeons" are just as important to improving outcomes as the allocation of resources in hospitals. However, Mark Chassin, a professor of health policy at Mount Sinai School of Medicine who was not involved in the study, said that volume of procedures in itself may not be a reliable measure of the quality of care provided by surgeons (Wall Street Journal, 11/28). An abstract of the study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.