NCPA - National Center for Policy Analysis

Surgeries At High Volume Hospitals Have Lower Death Rates

July 7, 2000

A recent study claims that more than 600 deaths annually in California and an estimated 4,000 deaths annually in the United States could be averted by sending elective surgery patients to hospitals that perform a high volume of the specific surgery. The deaths would be averted by avoiding hospitals that perform fewer surgeries and by referring all cases to a regional hospital which performs high volumes of the specific surgery. The new report finds at least 10 procedures and one medical condition had lower mortality levels in high volume hospitals than in low volume hospitals. For example:

  • Patients having abdominal aortic aneurysm repair at a low volume hospital were 64 percent more likely to die than those having the repair at a high volume hospital.
  • Children having heart surgery at a low volume hospital were 42 percent more likely to die than those having the same procedure at a high volume facility.
  • Patients having coronary artery bypass surgery were 39 percent more likely to die in a low volume hospital than those having the same surgery in a high volume hospital.

The study noted that there may be problems with implementing a system where all elective surgeries are done at a high volume facility. It is unknown whether the better outcomes are because "practice makes perfect" at these facilities or because patients are referred to better hospitals, with better support and post-surgery services. If it is merely a better hospital, an increase in patients could overload the system, actually increasing death rates.

Source: R Adams Dudley, et al., "Selective Referral to High Volume Hospitals: Estimating Potentially Avoidable Deaths," and John D. Birkmeyer, "High Risk Surgery -- Follow the Crowd," Journal of the American Medical Association, March 1, 2000.

 

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