The vast majority of hospitals fail to comply with the Leapfrog Group's minimum volume standards for eight high-risk surgeries, according to a new analysis.
The report, published Thursday, found most hospitals that participated in the 2018 Leapfrog Hospital Survey perform less than the recommended number of surgeries for the procedures to be performed safely. The Leapfrog Group's volume standards were set by a technical expert panel and target procedures where there is a strong correlation between outcomes and the number of times the procedures are performed, according to research.
"It's clear from this report that patients should be very careful before they choose a hospital for one of these high-risk procedures," said Leah Binder, president and CEO of the Leapfrog Group.
The American Hospital Association came out against Leapfrog's standards, calling them "arbitrary."
"There remains no definitive research about the exact volumes of procedures at which patient outcomes will improve significantly, which means that any prescribed number of procedures against which a hospital or surgeon are measured is arbitrary," said Nancy Foster, vice president of quality and patient safety policy at the AHA, in a statement.
She added that volume isn't the only measure important for safe surgical outcomes.
"Attributing surgical expertise solely to the number of procedures performed ignores the other important and effective strategies for improving safety," she said.
The Leapfrog analysis included 1,326 of the more than 2,000 hospitals that participate in the Leapfrog Hospital Survey because they perform at least one of the high-risk procedures. Leapfrog's standards target bariatric surgery, carotid endarterectomy, esophageal resection for cancer, lung resection for cancer, mitral valve repair and replacement, open abdominal aortic aneurysm repair, pancreatic resection for cancer and rectal cancer surgery.
Hospitals performed best on the bariatric surgery standard with 68.4% of hospitals complying with it and the carotid endarterectomy standard with 63.4% of hospitals meeting it. Hospitals fared much worse on the standards for the other procedures. For instance, only about 9.7% of hospitals met the volume standard for open abdominal aortic aneurysm repair.
In addition to volume standards for the hospitals, Leapfrog also has similar standards for surgeons.
"These procedures require ongoing practice by the surgeons ... that is coming from a plethora of literature on this subject," Binder said.
Most hospitals also failed to meet the surgeon volume standards for all the procedures except in the field of bariatric surgery. About 52% of hospitals met Leapfrog's surgeon standard for that procedure.
The better compliance with bariatric surgery overall is likely because the field has a more established set of protocols than other procedures highlighted, said Matt Austin, assistant professor at the Johns Hopkins Armstrong Institute, which has a contract with the Leapfrog Group and offers guidance. Additionally, many payers have set minimum volume standards for bariatric surgery.
"There seems to be more engagement from payers and regulators for this procedure compared to the other seven," he added.
The Leapfrog Hospital Survey also asks participants about practices they have in place to ensure surgeries are only performed when appropriate. The practices are intended to offset concerns that hospitals will perform unnecessary surgeries because volume is a proxy for quality, Austin said. Leapfrog requires that part of the practices involve establishing surgical appropriateness criteria and monitoring adherence to that criteria.
Less than half of hospitals complied with the standard for bariatric surgery. For the remaining procedures, less than one-third complied.
Binder said the poor performance could be partly explained by the fact that Leapfrog implemented these new standards just two years ago, so hospitals may need more time to comply.
"We will look for major improvement next year," she added.
