Experts: Very low-volume surgeons still 'concerning' for patient safety

Surgeons who perform just one of a specific type of surgery each year may be putting patients at risk for complications and worse outcomes, according to research published in JAMA Surgery.

Researchers examined data of all patients in New York who underwent elective open abdominal aortic aneurysm repair or carotid endarterectomy from 2000 to 2014. They compared data from very low-volume surgeons (those who performed one or less of those types of surgeries annually) to those of higher-volume surgeons.

They chose those two procedures in particular since those procedures are becoming less common overall, thanks to the advent of less-invasive options.

A total of 614 surgeons performed 8,781 OAR procedures and 1,071 surgeons performed 68,896 CEA procedures in the time period. Of those, 318 (51.8 percent) of OAR surgeons and 512 (47.8 percent) of CEA surgeons were very low-volume surgeons.

When compared to patients who went to higher-volume surgeons, OAR patients who went to a very low-volume surgeon were more likely to die in the hospital and stayed longer in the hospital. CEA patients had higher risks of postoperative heart attack and stroke and were more likely to be readmitted to the hospital.

"Although the percentage of very low-volume surgeons declined from 2000 to 2014, it remains concerning, given ready access to higher-volume surgeons" the study authors wrote. "Efforts to eliminate this practice pattern are warranted to ensure high-quality care for all patients."

In invited commentary published in JAMA Surgery Wednesday, two surgeons from Boston-based Beth Israel Deaconess Medical Center, wrote, "Working to eliminate the practice of very low-volume surgery, and ideally also low-volume surgery, will improve outcomes and may reduce disparities in vascular surgery outcomes."

This isn't the first study to link low-volume surgeons and hospitals to poor outcomes. Analysis from U.S. News & World Report in 2015 found when surgeons perform a low volume of cases of certain procedures, patients are at higher risk of death or serious complications.

In response to that finding, three major health systems — Dartmouth-Hitchcock Medical Center in Lebanon, N.H.; Baltimore-based Johns Hopkins Medicine and Ann Arbor-based University of Michigan — announced plans to ban hospitals from performing certain low-volume procedures.

"Low-volume hobbyists are bad for patients and we have to stop them," John Birkmeyer, MD, a surgeon and executive at Dartmouth-Hitchcock, said in 2015.

More articles on patient safety:
Poor hand hygiene, other safety errors identified at NJ clinic where 40 were infected
Mandatory use of bouffant caps does not impact SSI rates, study shows
Hospital door handles often harbor MRSA, study shows

© Copyright ASC COMMUNICATIONS 2017. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 


IC Database-3

Top 40 Articles from the Past 6 Months