Healthcare News & Insights

Surgery riskier at low-volume hospitals: How to respond

As the saying goes, practice makes perfect. And it’s no different for surgery at hospitals. In fact, according to a recent analysis, surgeons who don’t get enough practice have a higher risk of harming patients during procedures. 

ThinkstockPhotos-87462847U.S. News and World Report recently looked at the rates of injury for patients undergoing five different kinds of surgeries: elective hip and knee replacements, surgery for chronic obstructive pulmonary disease (COPD), bypass surgery without valve repair or replacement, and surgery for congestive heart failure.

According to the results, the picture doesn’t look pretty for hospitals with lower patient volume.

Knee replacement patients had a nearly 70% higher chance to die in the lowest-volume hospitals than in the highest volume hospitals. Hip replacement patients at the lowest-volume facilities were close to 50% more likely to die, and those with COPD or congestive heart failure had a 20% higher likelihood of dying after their surgeries.

And patients of lower-volume hospitals face other risks at higher rates as well. Example: They’re more likely to return to the hospital after joint replacement for a second surgery to correct issues such as mechanical failure or infection.

Although lower-volume hospitals see fewer patients, the numbers are still significant. Nearly 120,000 patients received care at the lowest-volume facilities for these conditions.

Reducing risks

The primary reason low-volume hospitals have higher rates of risk is due to lack of practice. While larger hospitals have lower risks of harm when it comes to common surgeries like joint replacements, even they aren’t free of problems. Every surgeon is occasionally asked to perform a procedure he or she doesn’t do often. And that inexperience increases the likelihood of poor outcomes.

That’s why some big-name facilities are employing a unique strategy to mitigate patients’ risk: They’re limiting the quantities of certain unfamiliar surgeries performed behind their walls.

Three top hospital systems: Johns Hopkins, the University of Michigan and Dartmouth-Hitchcock Medical Center have all decided to impose “minimum volume standards” to prevent hospitals from performing procedures unless they’re done often enough to keep surgical staff’s skills sharp, according to a different piece in U.S. News and World Report.

Specifically, the hospitals will be looking at procedures identified by research as having significantly higher risk when performed at facilities where they don’t happen frequently, including joint replacement, bariatric surgery, esophagus surgery and lung cancer surgery.

Each hospital will have its own formula to determine the minimum number of surgeries that must be performed in each category, and it’ll have room for flexibility when it comes to emergency procedures, new surgeons or surgeons who are coming back to the operating room from an extended break.

Other strategies

Taking measures to limit surgeries may not be feasible for many hospitals, especially those who rely on surgical volume to stay afloat. But other alternatives exist, including placing closer scrutiny on the procedures your hospital doesn’t perform as often on patients.

Another tactic that may be helpful: creating an “error room” where surgical staff can actually practice procedures they don’t encounter as often.

In the error room, surgical staff can test their skills when it comes to spotting issues that may harm patients. Having a simulated operating room for staff members to brush up on their technique gives them a safe environment to remind themselves of best practices to keep patients safe.

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