Healthcare News & Insights

Is limiting surgeries based on volume the right move?

It’s been debated for years: Are surgeries performed in high-volume facilities safer than those done in low-volume hospitals? Three health systems are urging others to adopt its practices for limiting procedures based on the surgeon’s experience, but it’s been an uphill battle so far. 

200252904-001Last year, the University of Michigan, Johns Hopkins, and Dartmouth-Hitchcock started requiring all their hospitals and surgeons to meet minimum thresholds for performing certain high-risk surgeries.

Their efforts so far were detailed in an article from Kaiser Health News.

Setting minimums

For the new initiative, each hospital mandated that surgeons must perform at least five pancreatic cancer surgeries a year if 20 of these operations occur in their hospitals annually. Otherwise, they’re not permitted to perform the surgery at all.

In addition, surgeons must perform 25 knee or hip replacements a year in a hospital that has 50 of these procedures per year to be eligible to operate on patients.

The guidelines give surgeons some leeway in emergencies, and there’s also a provision where surgeons who don’t meet the requirements due to being on leave can perform some procedures with supervision.

But for the most part, the health systems stick strictly to a system where high-volume facilities with experienced surgeons perform all surgeries with the highest potential for harm and complications.

The logic goes that practice refines doctors’ skills, so surgeons who have more experience with certain procedures are less likely to make mistakes that jeopardize patients’ health.

Many real-life examples support this theory. The Kaiser Health News article discusses cases where low-volume surgery programs put patients’ lives in danger – and may have even caused their deaths.

Example: Six babies who received heart surgery through a low-volume Florida hospital died within a two-year period. Those mortality rates were higher than expected for the types of surgeries the infants received. (Due to several issues, the hospital no longer performs these procedures on babies.)

Downsides to surgery limits

Although outcomes might be better when using benchmarks for volume, setting similar standards in other hospitals has been tough. In many smaller hospitals, the resources aren’t available to limit procedures to specific surgeons. They may not also treat enough patients to meet volume standards, and some professionals even believe the focus on volume is overrated.

Many clinicians say that patients tend to prefer care from the hospital that’s closest to their homes, even if it’s a low-volume facility for certain procedures. That preference alone is reason enough to continue offering the option for riskier surgeries at smaller hospitals.

Plus, not every larger, high-volume hospital meets the quality standards set by the feds and safety watchdog organizations for many procedures. So the risk for patient complications isn’t entirely removed by selecting a high-volume facility for surgery.

Limiting surgeries based on volume might not work for every hospital. But it’s still a smart move to take a look at how often your surgeons perform procedures like joint replacements – and compare that information to their patients’ outcomes. It could give you a good idea of areas to focus on for improvement or training for staff.

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