SURGICAL OUTCOMES: Mortality Rates Higher at ‘Low-Volume’ Hospitals
More than one in four deaths for certain procedures at California hospitals could have been avoided if patients had undergone surgery at a hospital that routinely performed a "high volume" of those types of procedures, according to at study published in this week's Journal of the American Medical Association. Researchers at the UC-San Francisco analyzed medical studies between 1983 and 1998 that showed an association between the number of procedures performed at a hospital and the death rates for those surgeries. Procedures included heart transplants, HIV/AIDS treatment, pancreatic cancer surgery and coronary artery bypass surgery. Taking into account the stage of disease and the patient's age, the researchers calculated "how much more likely patients were to die when they were treated in low-volume hospitals." Of the 121,609 patients studied, 58,306 were admitted to low-volume hospitals. Using information from a 1997 state database of hospital discharges, researchers estimated that of the 2,273 patients who died, 602 of those deaths were not caused by age or severity of illness. Noting that it is impossible for all patients to be referred to high-volume hospitals, researchers suggested that patients who can schedule surgery in advance could improve their survival rates by choosing a hospital that routinely performs the procedure. Lead author Dr. R. Adams Dudley said, "There are real life-and-death differences between hospitals, and that shouldn't be ignored."
The study comes at a time when an increasing number of insurers and employers are pressing for such information. The San Francisco-based Pacific Business Group on Health, an insurance purchasing organization that represents 2.5 million employees, last year began asking insurers to refer patients to high-volume hospitals when possible. However, some groups took issue with the study. Melissa Stafford Jones, a spokesperson for the California Health Care Association, warned, "The science of looking at medical outcomes is a new science, and volume (of procedures) is a blunt measure of quality. Before we make large-scale policy changes, we need to (come up with) finer measures of quality." Mary Ferguson, a nurse and chief quality officer for San Jose Medical Center, said that the study could be misleading since it combines the performance of all low-volume hospitals, which can "obscure the good performance of individual hospitals" (Feder, San Jose Mercury News, 3/1).