Risk of patient harm is high at low-volume hospitals, study finds

When surgeons at a hospital perform a low volume of cases of certain procedures, patients are at a higher risk of suffering death or serious complications than if the surgeons and hospitals have more experience, according to analysis from U.S. News & World Report.

In fact, as many as 11,000 deaths in the U.S. from 2010 through 2012 could have been prevented if those patients who had gone to the lowest-volume fifth of hospitals had gone to the highest-volume fifth for five common procedures.

Part of U.S. News' analysis identified every hospital across the nation that treated fewer than 25 traditional Medicare inpatients from 2010 through 2012 for nearly 20 frequent procedures and conditions.

The analysis found that knee-replacement patients at these ultra-low-volume hospitals had double the national average death risk and a 25 percent higher rate of readmission due to post-discharge complications.

Similarly, hip-replacement patients at ultra-low-volume hospitals had a 77 percent higher risk of death and a 25 percent higher risk of readmission.

The bulk of the analysis involved dividing all centers that treated at least 25 patients in one or more of the operations or conditions — like hip replacements, knee replacements, heart failure, heart bypass surgery and chronic obstructive pulmonary disease — into five roughly equal volume categories. The rates of death and complications were then calculated for each category.

That analysis found that:

  • Patients who had knee replacement surgery in the lowest-volume centers were nearly 70 percent more likely to die than patients treated at hospitals in the top quintile for volume.
  • Risk of death for hip replacement patients was nearly 50 percent higher.
  • Patients with congestive heart failure and COPD had a 20 percent increased risk of death.

This U.S. News analysis is part of the research done for a new set of hospital ratings, Best Hospitals for Common Care, which will be released Wednesday.

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