Older patients have lower mortality rates for eight types of cardiovascular and cancer surgeries if the surgeons performing the operations are highly experienced in the specific procedures, a new scientific paper says.
Writing in the Nov. 27 issue of the New England Journal of Medicine, researchers led by John Birkmeyer, M.D., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., find that patients of high-volume surgeons are more likely to survive major surgery than those who go to surgeons with less experience.
The researchers looked at all 474,000 records in the Medicare claims database for 1998 and 1999 of patients who underwent coronary artery bypass graft, carotid endarterectomy, aortic valve replacement, elective repair of aortic aneurysm, pancreatic resection, esophagectomy, lung resection or cystectomy surgeries.
According to the study, a patient was 24% more likely to die from complications during lung resection or within 30 days after the operation if the surgeon performed fewer than seven of the procedures annually, as compared to a surgeon who does more than 17 a year. Mortality for pancreatic resection is nearly four times higher with low-volume physicians than with those with more experience.
The trend holds up even at low-volume hospitals.
"People often assume that the problem of low-volume surgery is a function of small community and rural hospitals," Birkmeyer says. "For most operations, surgeon volume matters as much or more than hospital volume as a predictor of outcomes."
Birkmeyer also led a team that published a study on surgical volume for hospitals in the Nov. 26 Journal of the American Medical Association.
That paper finds that setting relatively low minimum volume standards for hospitals to perform two high-risk elective surgical procedures would not force large numbers of patients to travel out of their way for operations, but raising the threshold significantly might add unreasonable burdens.
Birkmeyer says that data from these two studies might lead to the elimination of the "most blatant instances of low-volume surgeries" at some hospitals. He says he envisions a lowering of the bar for volume at hospitals and increased reporting of individual surgeon volume.
"We're not asking some surgeons to work harder or do more cases," Birkmeyer says. "Surgeons would be better off narrowing the focus of what they choose to specialize in."