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Should Procedure Volume Be Considered a Measure of Quality?

Hospital procedure volume does not appear to be a significant predictor of mortality for the performance of panceatectomy, abdominal aortic aneurysm repair, esophagectomy, or CABG. An analysis of discharge data from more than 260,000 patients found mortality risk to instead be primarily attributable to patient-level characteristics. Abstract: Annals of Surgery, October 2012....

Rural & Urban Differences in Surgeries

Previous investigations have shown that there are disparities in healthcare services provided to rural and urban residents. Removing these disparities has become a national priority because good healthcare shouldn’t depend on where people live. Disparities in care to rural residents can have important implications for how healthcare resources are allocated. For example, patient outcomes are typically better with hospitals and surgeons performing higher volumes of given procedures. Outlying rural hospitals may be performing lower volumes of these procedures, but it’s important to balance this with the need for these procedures if there are no nearby hospitals and surgeons. Rural Vs Urban Settings In an effort to better understand the association between receipt of greater and lesser discretionary surgeries among residents in rural versus urban settings, my colleagues and I conducted an analysis that was published in the May 2011 Archives of Surgery. In this analysis, we analyzed disparities between settings by looking at the incidences of several elective procedures (lumbar spine fusion, total hip and knee replacement surgery, and prostatectomy) as well as that of less discretionary procedures (abdominal aortic aneurysm repair [AAA], aortic valve replacement, non-incidental appendectomy, open reduction and internal fixation of the femur, and carotid endarterectomy [CEA]). According to our findings, rural Medicare beneficiaries were significantly more likely than their urban counterparts to undergo a wide variety of surgical procedures. These procedures ranged from those that were generally more discretionary, especially total joint replacement surgery and lumbar spine fusion, to those that were generally less discretionary, including CEA and appendectomy. The magnitude of this difference was also important to note. Rural patients were at least 20% more...

Hospital Volume & Mortality: Trends in High-Risk Surgery

A growing number of studies have reported inverse relationships between hospital volume and surgical mortality, with lower mortality seen in higher-volume institutions. There have been numerous efforts to concentrate selected operations at high-volume hospitals. The Leapfrog Group, a consortium of large corporations and public agencies that purchase healthcare for their employees, has been among the most prominent advocates of volume-based referrals. Private payers and professional organizations have also established minimum-volume standards as part of Centers of Excellence accreditation programs for a variety of operations. “Despite these efforts, little is known if they have altered referral patterns for high-risk surgery,” says Jonathan F. Finks, MD. Throughout the country, more and more surgical patients are being treated at high-volume hospitals, but the net effects on operative mortality can be difficult to predict. Dr. Finks says, “for example, hospital volume of a few high-risk cancer procedures, such as pancreatectomy, appears to be a strong predictor of operative risk. At the same time, relationships between surgical volume and outcome are much weaker for most operations.” “Some strategies that appear to be of particular benefit include use of operating-room checklists, outcomes measurement and feedback programs, and national and regional collaborative quality-improvement initiatives.” In a study published in the June 2, 2011 New England Journal of Medicine, Dr. Finks and colleagues at the University of Michigan used data from national Medicare claims to evaluate trends in the use of high-volume hospitals for major cancer resections and cardiovascular surgery. The investigators identified patients (aged 65 to 99) who underwent one of the following cancer and cardiovascular operations from 1999 through 2008: 1) esophagectomy, 2) pancreatectomy, 3) lung...
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