High-Risk Operations Less Risky Now

Surgery deaths decrease across the board for risky surgeries

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Surgical, anesthetic and hospital expertise are improving everyday. Because more high risk surgeries are performed in sophisticated, state of the art institutions, surgery death rates have dropped in the past 10 years.

A recent study published in New England Journal of Medicine reports death rates for pancreatectomy declined 67 percent, esophagectomy declined 32 percent and cystectomy declined 37 percent.

"Surgery is safer in a high-volume hospital."

Lead author Jonathan F. Finks, M.D., clinical assistant professor of surgery at the University of Michigan Health System comments that patients should be reassured as all high-risk surgeries have become much safer in the this century. In cancer surgery, mortality has dropped in large part because more patients are having their surgery in safer, higher volume hospitals which are equipped to handle high risk surgeries.

Hundreds of low-volume U.S. hospitals have essentially stopped doing high-risk cancer surgery, i.e. the number of Medicare patients needing surgery to treat pancreatic cancer over the last 10 years has increased by 50 percent, but the number of hospitals performing the surgeries decreased by 25 percent.

There have been numerous efforts in the United States to concentrate selected operations at high volume hospitals. The Leapfrog group, a consortium of large corporations and public agendas that purchase health care largely for their employees, has been among the most prominent advocates of volume-based referrals.

John Birkmeyer, M.D., professor of surgery and director of the U-M Center for Healthcare Outcomes and Policy, counters that there is more to to making surgery safer across the board than just concentrating surgeries in experienced hospitals. He adds “For some procedures...strategies such as operating room checklists, outcomes measurement programs, and quality improvement collaboratives are likely to be more effective than volume-based referral.”

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Review Date: 
June 3, 2011
Last Updated:
June 9, 2011